Fillable Uia 1772 Form PDF Details

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QuestionAnswer
Form NameFillable Uia 1772 Form
Form Length3 pages
Fillable?Yes
Fillable fields78
Avg. time to fill out16 min 25 sec
Other namesuia 6347 request for information form, uia form 6347, uia 6347 form download, form uia 6347

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UIA 1772

 

RESET FORM

 

 

(Rev. 04-18)

STATE OF MICHIGAN

 

GRETCHEN WHITMER

DEPARTMENT OF LABOR AND ECONOMIC OPPORTUNITY

GOVERNOR

UNEMPLOYMENT INSURANCE AGENCY

Authorized by

MCL 421.1 et seq.

SUSAN CORBIN

ACTING DIRECTOR

 

Notice of Change

Information shown on this report is used to determine termination of liability under Section 24 of the Michigan Employment Security (MES) Act. Completion of this report is required even though you may not be currently employing any workers. Failure to provide this information may result in a determination being made based on information available to Unemployment Insurance. Penalties may be imposed under Section 54(a) or 54(b) of the MES Act for an intentional failure to comply with State law.

PART I: EMPLOYER INFORMATION

1.Current name and address.

a.Employer Account Number (EAN): ____________ Federal Employer ID (FEIN): _________________

b.Employer Name: ___________________________________________________________________

c.Mailing Address: ____________________________________________________________________

d.Telephone: __________________________

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, please attach additional pages to provide information on all owners.

a.Name: _________________________________ SSN: _________________ Birth Date: ___________

Address: ___________________________________________________________________________

Title: ______________________________Telephone: ______________ Record Holder: Yes No

b.Name: _________________________________ SSN: _________________ Birth Date: ___________

Address: ___________________________________________________________________________

Title: ______________________________Telephone: ______________ Record Holder: Yes No

c.Name:_________________________________ SSN:__________________ Birth Date: ____________

Address: ___________________________________________________________________________

Title: ______________________________Telephone: ______________ Record Holder: Yes No

3.Reason(s) for discontinuance or transfer of payroll or assets in whole or part (check one or more).

Sale

 

Reorganization

 

New Partnerships

Lease

 

Bankruptcy

 

Incorporation

Foreclosure

 

Dissolution/Discontinuance

 

No Employees

Merger

 

Death

 

 

Other (explain): _____________________________________________________________

4.

Provide the following information:

 

 

 

a. Date of last payroll: ______________________

 

 

5.

Provide the following information:

 

 

 

a. Did you discontinue all employment in Michigan?

Yes

No

 

If no, how many employees were retained?

______

 

 

b. Have you continued or resumed business in Michigan?

Yes

No

UIA 1772 (Rev. 04 -18) Page 2

If you answered yes to question #5b, complete the section below if the information differs from what

was provided in question #1.

 

___________________________________

__________________________________________

Legal Name of Business

Address

___________________________________

__________________________________________

Nature of Business

Date(s) Resumed Business

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

PART II: NEW OWNER INFORMATION

Please 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. 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.

New Owner’s Name

New Corporation Name or DBA

Current Street Address (No PO Box)

City, State, Zip Code

New Owner’s UI Account Number or FEIN, if known.

Area Code & Telephone Number

PART III: ACQUISITION INFORMATION:

Complete this section 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 below.

1.Did the above acquire all, part, or none of the assets of any former business?

a.Number of business location in Michigan:

b.Number of business location in Michigan that have been discontinued:

2.Did the above acquire all, part, or none of the organization (employees/payroll/personnel) of any former business?

a.If all or part, indicate the percent and date acquired

b.Did the above acquire all or part of the employees/payroll/personnel of any former business by leasing any of those employee/payroll/personnel?

 

All

Part

None

What

Date

 

 

 

 

 

 

 

 

 

Percentage

Acquired

 

 

 

 

 

 

 

 

 

________%

_______

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All

Part

None

 

 

 

What

Date

 

 

Percentage

Acquired

 

 

________%

________

Yes

No

If yes, provide a copy of your

 

 

lease agreement.

 

3.Did the above acquire all, part, or none of the trade (customers/accounts/clients) of any former business?

4.Did the above acquire all, part, or none of the former owner’s Michigan business (products/services) of any former business?

5.Was your Michigan business described in 1-4 above being operated at the time of acquisition? If no, enter the date it ceased operation.

All

Part

None

What

Date

 

 

 

percentage

Acquired

 

 

 

_______%

________

All

Part

None

What

Date

percentage

Acquired

 

 

 

_______%

________

Yes

No

Date operation ended

 

 

__________________

 

UIA 1772

 

 

(Rev. 04-18)

 

 

Page 3

 

 

6. Is the above conducting/operating the Michigan business

Yes

No

acquired from you?

 

 

7.Is the above substantially owned, merged, or controlled in any way by the same interests who owned or controlled the organization, business or assets of your business?

8.Did the above hold any secured interest in any of the Michigan assets acquired from you?

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

Yes

No

If Yes, complete this Form

and fill out Schedule B of

 

 

Form 518.

Yes

No

If Yes, enter balance owed

 

 

$______________

$______________

CERTIFICATION

I certify that the information contained in this report is accurate and complete to the best of my knowledge and belief. I understand that if I fail to provide accurate and complete information on this form, I may be subject to penalties of up to four times the amount of resulting unpaid unemployment taxes and imprisonment for up to five years.

____________________________________

______________________

Name

Date

____________________________________

_______________________

Title

Telephone Number

When a complete transfer of a Michigan business is involved:

Your final Quarterly Wage/Tax Report must be filed and paid within 15 days,

Your coverage will be terminated as of the transfer date,

If 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

IIand Part III above, should be kept available for examination by Unemployment Insurance for six years.

You may submit this Form through your Michigan Web Account Manager (MiWAM) account or via fax to 1-313- 456-2130. If you are mailing this form, please send it to Unemployment Insurance, Tax Office, PO Box 8068, Royal Oak, Michigan 48068-8068

If your address changes it is important to update it with Unemployment Insurance.

If you have any questions, contact the Office of Employer Ombudsman (OEO) through your MiWAM account or at 1-855-4UIAOEO (855-484-2636). TTY customers call 1-866-366-0004.

LEO is an equal opportunity employer/program.

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filling out form 6347 part 1

Type in the appropriate data in the Providethefollowinginformation, aDateoflastpayroll, and Providethefollowinginformation section.

step 2 to entering details in form 6347

Note down the demanded data once you are within the Providethefollowinginformation, and Ifnohowmanyemployeeswereretained box.

Finishing form 6347 part 3

Describe the rights and responsibilities of the parties inside the box AddressDatesResumedBusiness, NewOwnersName, NewCorporationNameorDBA, CurrentStreetAddressNoPOBox, CityStateZipCode, and AreaCodeTelephoneNumber.

Filling out form 6347 stage 4

Fill in the form by taking a look at all of these fields: beendiscontinued, All, Part, None, What, Percentage, DateAcquired, All, Part, None, What, Percentage, Yes, All, and Part.

Completing form 6347 part 5

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