UIA 1772: Michigan Notice of Change

In 1, Current name and address, enter the Employer Account Number (EAN), the Federal Employer ID (FEIN), the Employer Name, the Mailing Address and the Telephone.

In 2, provide the following information concerning the owner(s), partners, corporate officers, LLC member(s), etc., of the organization and the person(s) who safeguard the company's books and records.

If necessary, attach additional pages to provide information on all owners.

For each of a, b and c, enter the Name, SSN, Address, Title, Telephone and Birth Date, and mark Record Holder Yes or No.

In 3, check one or more reasons for discontinuance or transfer of payroll or assets in whole or part: Sale, Reorganization, New Partnerships, Incorporation, Lease, Bankruptcy, Dissolution/Discontinuance, Foreclosure, No Employees, Merger, Death or Other (explain).

In 4, enter the Date of last payroll.

In 5a, mark Yes or No for Did you discontinue all employment in Michigan? If no, enter how many employees were retained. In 5b, mark Yes or No for Have you continued or resumed business in Michigan?

If you answered yes to Have you continued or resumed business in Michigan?, complete Legal Name of Business, Address, Nature of Business and Date(s) Resumed Business if the information differs from what was provided in question 1.

In Part II: New Owner Information, provide the name(s) of the person(s) who acquired the Michigan assets, Michigan organization, Michigan trade, or Michigan business.

"Acquired" refers not only to assets purchased, but also assets acquired by rental, lease, use, inheritance, merger, mortgage, foreclosure, gift, or other transfer.

Enter the New Owner's Name, the New Owner's UI Account Number or FEIN, if known, the New Corporation Name or DBA, the Area Code & Telephone Number, the Current Street Address (No PO Box) and the City, State, Zip Code.

If more than one individual or organization is involved, answer all parts of this question for each purchaser, using separate sheets. If preferred, additional forms will be supplied upon request.

Complete Part III: Acquisition Information carefully. It might be necessary to consult your accountant, attorney, or financial advisor for a complete valuation of your entire business to accurately determine the percentage of transfer for each item.

In 1, mark All, Part or None for the assets of any former business and enter What percentage and Date Acquired. In 1a, enter the Number of business location in Michigan. In 1b, enter the Number of business location in Michigan that have been discontinued.

In 2, mark All, Part or None for the organization, the Number of Employees (employees/payroll/personnel), of any former business. If all or part, indicate the percent and date acquired.

Mark Yes or No for Did the New Owner acquire all or part of the employees/payroll/personnel of any former business by leasing any of those employee/payroll/personnel. If yes, provide a copy of your lease agreement.

In 3, mark All, Part or None for the trade (customers/accounts/clients) of any former business, with its What percentage and Date Acquired.

In 4, mark All, Part or None for the former owner's Michigan business (products/services) of any former business, then fill in What percentage and Date Acquired.

In 5, mark Yes or No for Was your Michigan business described in 1-4 being operated at the time of acquisition? If no, enter the date it ceased operation as the Date operation ended.

In 6, mark Yes or No for Is the New Owner conducting/operating the Michigan business acquired from you.

In 7, mark Yes or No for Is the New Owner substantially owned, merged, or controlled in any way by the same interests who owned or controlled the organization, business or assets of your business. If Yes, complete this Form and fill out Schedule B of Form 518.

In 8, mark Yes or No for Did the New Owner hold any secured interest in any of the Michigan assets acquired from you. If Yes, enter balance owed.

In 9, enter the reasonable value of the Michigan organization, trade, business or assets sold or transferred.

By signing, you certify that the information contained in this report is accurate and complete to the best of your knowledge and belief.

Enter your Name, Date, Title and Telephone Number.

Complete Part II and Part III only if your business was sold or transferred.

When a complete transfer of a Michigan business is involved, your final Quarterly Wage/Tax Report must be filed and paid within 15 days and your coverage will be terminated as of the transfer date.

When a complete transfer of a Michigan business is involved and you have persons in your employ after the transfer date of your business, you need to notify Unemployment Insurance immediately to determine if you are liable for taxes on that payroll.

When a partial transfer of a Michigan business is involved, you need to continue to report and pay taxes if you have Michigan workers in your employ or until your coverage is terminated.

All documents, agreements or records describing the transactions indicated in Part I Item 4, Part II and Part III should be kept available for examination by Unemployment Insurance for six years.

You may cease the employer account through MiUI or via fax to 1-517-636-0014. If you are mailing this form, send it to Unemployment Insurance, Tax Office, PO Box 8068, Royal Oak, Michigan 48068-8068.

Penalties may be imposed under Section 54(a) or 54(b) of the MES Act for an intentional failure to comply with State law. If you fail to provide accurate and complete information on this form, you may be subject to penalties of up to four times the amount of resulting unpaid unemployment taxes and imprisonment for up to five years.