Fillable DISPOSITION OF BUSINESS

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DISPOSITION OF BUSINESS

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JFS 66308 (Rev. 12/2009) Page 1 of 2
Ohio Department of Job and Family Services
DISPOSITION OF BUSINESS
Attention: Contribution Section
P.O. Box 182404
Columbus, Ohio 43218-2404
(614) 466-2319 extension 22485
www.jfs.ohio.gov
1.a. Employer Name 1.b. Employer Trade Name
1.d. Telephone # 1.c. Employer ODJFS Account #
1.e. E-mail Address
2. How did you dispose of your business?
Discontinuance Foreclosure Sale Incorporation Partner Addition
Dissolution Formed LLC Lease Merger Partner Withdrawal
Court Order
(Name of court)
Leasing Employees
(Name of company) (Effective date)
Other (explain):
3. Attach a copy of any agreement or contract related to the disposition of your business.
4.a. On what date did you dispose of your trade or business? 4.b. Was the trade or business being operated in Ohio at the time of
disposition?
Yes No
4.c. If no, when did your trade or business cease operation? 4.d. When did you last employ any workers in Ohio?
5. If a new owner is operating the trade or business, provide:
NEW OWNER’S NAME BUSINESS (trade name)
(street address) (city) (state) (zip) (telephone #)
6.a. Did the new owner acquire all of your trade or business locations in Ohio?
Yes No
6.b. If no, list the trade or business locations you still operate in Ohio (if not sufficient space, attach supplemental sheet)
(trade or business name) (city) (state) (zip) (date operation began)
7.a. Did the new owner acquire all of your trade or business in
Ohio?
Yes No
7.b. If no, list the parts of the trade or business in Ohio which you
retained.
8. Person in charge of payroll records and address where payroll records are kept.
(name) (city) (state) (zip) (telephone #)
CERTIFICATION: I hereby certify that the information given in this report is true to the best of my knowledge and belief.
(employer signature) (title) (date)
(street address) (city) (state) (zip) (telephone #)
INFORMATION FURNISHED ON THIS REPORT WILL BE USED TO DETERMINE LIABILITY FOR CONTRIBUTIONS UNDER THE
OHIO UNEMPLOYMENT COMPENSATION LAW.
Prepared by (name) (telephone #) (date)
PLEASE SEE REVERSE SIDE FOR LAW AND RULES APPLICABLE TO THIS FORM AND THE TOTAL AND PARTIAL
TRANSFER OF EMPLOYMENT EXPERIENCE.
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DISPOSITION OF BUSINESS

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Completed 8 March 2021

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