Fillable Uia 1772 Form – Fill Out and Use This PDF

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Fillable Uia 1772 Form PDF Details

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Question	Answer
Form Name	Fillable Uia 1772 Form
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	uia 6347 request for identity verification form, uia form 6347, form uia 6347 pdf, uia 6347 form download

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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
All	Part	None	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
Yes	No	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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Type in the data demanded by the software to get the document.

filling out uia 6347 form michigan pdf part 1

Type in the appropriate data in the a Employer Account Number EAN, Provide the following information, members etc of the organization, a Name SSN Birth Date Address, b Name SSN Birth Date Address, c Name SSN Birth Date Address, Reasons for discontinuance or, Sale Lease Foreclosure Merger, Reorganization Bankruptcy, and New Partnerships Incorporation No section.

step 2 to entering details in uia 6347 form michigan pdf

Note down the demanded data once you are within the Sale Lease Foreclosure Merger, Reorganization Bankruptcy, New Partnerships Incorporation No, Provide the following information, a Date of last payroll, Provide the following information, a Did you discontinue all, Yes, If no how many employees were, and b Have you continued or resumed box.

Finishing uia 6347 form michigan pdf part 3

Describe the rights and responsibilities of the parties inside the box If you answered yes to question b, Address, Nature of Business, Dates Resumed Business, Complete Part II and Part III only, PART II NEW OWNER INFORMATION, New Owners Name, New Corporation Name or DBA, Current Street Address No PO Box, City State Zip Code, New Owners UI Account Number or, and Area Code Telephone Number.

Filling out uia 6347 form michigan pdf stage 4

Fill in the form by taking a look at all of these fields: Did the above acquire all part or, of any former business, a Number of business location in, b Number of business location in, been discontinued, All, Part, None, What Percentage, Date Acquired, Did the above acquire all part or, All, Part, None, and If all or part indicate the.

Completing uia 6347 form michigan pdf part 5

Step 3: When you are done, select the "Done" button to upload the PDF form.

Step 4: You should create as many duplicates of the form as possible to avoid future issues.

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