Fillable Notice of Change Form (Illinois)

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Notice of Change Form (Illinois)

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The Notice of Change Form (Illinois) form is 4 pages long and contains:

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Country of origin: US
File type: PDF

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Notice of Change Form
Revised: March 2020
All account maintenance can be completed at MyTax.Illinois.gov. Online submission provides a
confirmation that your submission was received as well as eliminates the wait time associated with
traditional mail or fax and in many cases can be automatically processed.
To Change your Name (without change in legal entity), Address, or Phone Number:
1. Logon to mytax.illinois.gov
2. Select the “Names and Address” tab
3. Click the hyperlink of the item you want to change.
4. Follow and complete steps
To Close your Account:
1. Logon to mytax.illinois.gov
2. Go to your “Unemployment Insurance Account”
3. Enter the reason for closing your account and enter at least on of the dates requested on the
page.
4. Under the “Account Maintenance” heading select “Request to Close Account”
5. Follow and complete steps
For more information contact IDES Employer Hotline at 1-800-247-4984
UI-50A (Rev. 11/17)
Page 1 of 3
THE EMPLOYING UNIT NAMED ABOVE GIVES NOTICE OF CHANGE(S) WITH RESPECT
TO ITS BUSINESS EFFECTIVE:
1. Name Change/Address Change/Miscellaneous Changes
Name changed without change in legal entity.
Doing Business As name changed without change in legal entity.
Business address changed. New address
New name
(Street)
(City) (State) (Zip)
New DBA name
Telephone number changed. New telephone number
Mailing address changed.
If you have multiple mailing addresses, complete UI-1M, Unemployment Insurance Special Mailing Form.
If the Mailing Address is for an authorized representative, you must attach a Power of Attorney.
(Street) (City) (State) (ZIP) (Telephone Number)
()
Please answer these questions carefully. Your answers may impact upon your liability for
unemployment insurance contributions.
()
If the business is closing, skip all other questions and sign on the last page.
If you reorganized, sold your business or transferred your employees to another business enterprise, you must
also complete the following pages.
The name, business address and telephone number of the person in possession of all of your payroll and employment
records which pertain to periods prior to the latest date given in A, B or C
C. Date on which you ceased paying wages, if later than the date shown in A or B above
ExplainB. Date you ceased employing workers, if you are still operating in Illinois
ExplainA. Date you discontinued operations in Illinois
2. Request to Close Account
Employer Name
DBA Name
Address
City, State, ZIP
Date
Account #
Notice of Change
33 South State Street, Chicago, Illinois 60603
Phone: 800-247-4984 | Fax : 217-557-1948
UI-50A (Rev. 11/17)
Page 2 of 3
3. Reorganization, Sale or Other Organizational Change. Check all items that apply to you. If any item in this section is
checked, please complete numbers 4 & 5 below.
Name of deceasedPartnerOwner;
Death of:
Case Number
//
DateType of bankruptcy
Assignment for benefit of creditorsBankruptcy;Foreclosure; Receivership;
Corporate merger, consolidation or reorganization (Explain in detail)
Partnership reorganization (Explain in detail)
FEIN
CorporationPartnershipSole Proprietorship
To:
From:
Change in type of business structure
In part (Explain)Entirely;Lease of enterprise:
In part (Explain)Entirely;Sale of enterprise:
Fed. ID. Number (if known)Illinois U.I. account number (if known)
Doing business as (if known)
Name of new owner
Date of transaction
4. If any of the items in #3 above are checked, furnish the following information:
D. List the name and address of the Illinois business locations you retained or continued to operate:
(If necessary, attach an additonal sheet of paper.)
C. What number of locations did the new owner acquire?
NoYes
B. Did the new owner acquire all of your business locations in Illinois?
NoYes
A. Did you operate at more than one location in Illinois?
5. Furnish the following information with respect to your Illinois operations if you disposed of or leased only a portion of
your business enterprise:
Location 6
Location 5
Location 4
Location 3
Location 2
Location 1
County Zip
StateCity/TownName and address
(If No, skip to E.)
Other (Explain, e.g., Limited Liability Company,
Trust, Association, Receivership)
FEIN Trust, Association, Receivership)
Other (Explain, e.g., Limited Liability Company,CorporationPartnershipSole Proprietorship
Address:
Notice of Change
33 South State Street, Chicago, Illinois 60603
Phone: 800-247-4984 | Fax : 217-557-1948
UI-50A (Rev. 11/17)
Page 3 of 3
E. Is the Illinois business still owned, managed or controlled in any way by the same interests that owned, managed or
controlled the former business?
NoYes
How many of them does the new owner employ?
If No, how many people were employed by you?
NoYes
G. Is the new owner employing all of the same people that you did on the last day of business?
%
Percent of operations retained by you
%
If No, what is the percentage acquired by the new entity?
NoYes
F. Did the new owner acquire all of the Illinois operations?
Franchisor?Franchisee or the
If Yes, were you the
NoYes
L. Is this business a franchise?
Phone NumberAddress
Name
If neither you nor the new owner, who is conducting the business?
If No, are you conducting the business?
Yes
NoYes
No
K. Is the new owner conducting the Illinois business which the new owner acquired?
J. What was your trade or business ?
If yes, what %?Yes
I. Did the new owner acquire any of your Illinois trade or business?
If yes, what %?NoYes
H. Did the new owner acquire any of your assets?
No
This state agency is requesting information that is necessary to accomplish the statutory purpose as outlined under 820 ILCS
405/100-3200. Disclosure of this information is Required. Failure to disclose this information may result in statutorily prescribed
liability and sanction, including penalties and/or interest.
HOME TELEPHONE NUMBER
HOME ADDRESS OF OFFICIAL
SIGNED BY
DATE SIGNED AND SUBMITTEDBUSINESS NAME
CERTIFICATION: I HEREBY CERTIFY THAT THE FOREGOING INFORMATION AND THAT CONTAINED IN ANY ATTACHED
SHEETS SIGNED BY ME IS TRUE AND CORRECT. THIS REPORT MUST BE SIGNED BY OWNER, PARTNER, OFFICER OR
AUTHORIZED AGENT WITHIN THE EMPLOYING ENTERPRISE. IF SIGNED BY ANY OTHER PERSON, A POWER OF
ATTORNEY MUST BE ON FILE.
)(
%
Percent of assets retained by you
TITLE
Notice of Change
33 South State Street, Chicago, Illinois 60603
Phone: 800-247-4984 | Fax : 217-557-1948
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Notice of Change Form (Illinois)

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Completed 10 December 2020

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