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518 Schedule B (Rev. 11-07)

UIA Schedule B - Successorship Questionnaire

Issued under authority of the Michigan Employment Security Act of 1936, as amended, MCL 421.1 et seq. Filing is mandatory for employers.

You must complete all items on this form accurately and completely. Failure to do so may subject you to the penalties

provided under the Michigan Employment Security (MES) Act. Attach additional sheets if necessary.

Successorship Reporting Requirement. If you acquired any part of the Michigan assets, trade or business of another

employer, as defined in Part 3 of this form, by purchase, rental, lease, inheritance, merger, foreclosure, bankruptcy, gift or any

other form of transfer, you must provide the following information. If you made multiple acquisitions, you must file a separate

UIA Schedule B for each acquisition (photocopies of this form are acceptable). If you made no acquisitions, you are still

required to complete this schedule. If subsequent to completing this registration form, you transfer the assets (by sale or

transfer), organization (payroll/employees), trade (customers/accounts), or business (products/services), in whole or in part, to a

new or previously existing business in Michigan, it is mandatory that you notify this Agency immediately by completing an

additional Schedule B.

UIA Account Number

Federal Employer

(if already assigned)

Identification No. (required)

PART I: QUESTIONS ABOUT PRIOR OR CURRENT BUSINESS FORMATIONS, ACQUISITIONS OR MERGERS

For each of the following five business formation, acquisition or merger types, the employer must indicate the pertinent business

name, address and UIA Account Number in the space provided.

1. In the past 6 years, have you formed, acquired or merged with a business by any means?

If no, check box

and

continue. If yes, provide the following:

Business Name and Address

UIA Account Number

If you formed a new business, what did you acquire from the previously existing business? (check all that apply)

Land

Buildings

Furniture/Fixtures

Equipment

Inventory

Accounts Receivable

Goodwill

Employees

Trade

Customer Accounts

None

b. If you purchased, acquired or merged with an existing business by any means (including lease), what assets did you acquire?

(check all that apply)

Land

Buildings

Furniture/Fixtures

Equipment

Inventory

Accounts Receivable

Goodwill

Employees

Trade

Customer Accounts

None

c. What was the business activity of the previous business?

2. At the current time, are you forming or acquiring a business by any means?

If no, check box

and continue, If yes,

provide the following:

Business Name and Address

UIA Account Number

a. If you formed a new business, what did you acquire from a previously existing business? (check all that apply)

Land

Buildings

Furniture/Fixtures

Equipment

Inventory

Accounts Receivable

Goodwill

Employees

Trade

Customer Accounts

None

b. If you are purchasing or acquiring an existing business by any means (including by lease), what assets are you acquiring?

(check all that apply)

Land

Buildings

Furniture/Fixtures

Equipment

Inventory

Accounts Receivable

Goodwill

Employees

Trade

Customer Accounts

None

c. Will any owner or owners of the previous business continue to operate or manage the business being registered by this form?

Yes

No If yes, provide name, title and business address below.

d. What was the business activity of the previous business?

e. What will be the business activity, if any, of the previous business after the new business being registered is formed?

What will be the business activity of the new business being registered by this form?

Form 518, Michigan Business Taxes Registration Booklet - Michigan Department Of Treasury Page 11

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