Free 46799.pdf - Indiana

REPORT OF TRANSFER - COMPLETE SALE
State Form 46799 (R/2-96)

· · · ·

INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT 10 N. SENATE AVE. INDIANAPOLIS IN 46204-2277 (317) 232-7436

To be filed by the previous owner (disposer). This must be submitted within 10 days after disposing and acquiring employers are mailed final notice. Any employing unit which fails to submit any report required within 10 days after request is sent by registered mail shall be assessed a penalty of $25.00. Reference Indiana Code 22-4-19-10. Any employing unit shall have 15 days within which to protest in writing determinations with respect to successorship's . . . period shall commence the day following the day upon which the determination is mailed. Reference Indiana Code 22-4-32-4. If you disposed of, or leased, only a portion of your Indiana business assets, do not complete this form. You are required to complete State Form 23299, Report of Transfer - Partial Sale.

NOTE:

This report must be filed if: (check one) Sale of Complete organization Lease of Complete organization Other (explain fully): Corporate change or reorganization Changed Federal ID number Partnership change (50% or more) Death of owner or partner

Please type or print in ink.
Effective date of change: (mm/dd/yy) Date disposer operations ceased: (mm/dd/yy) Date of last payroll for disposer organization: Disposer's Indiana SUTA No.: Legal name of employing unit: d/b/a: Business activity: Current address: City: Contact person: Acquirer's Indiana SUTA No.: Legal name of employing unit: d/b/a: Business activity: Current address: City: Contact person: State: Telephone No.:
(

FOR OFFICE USE ONLY
Disposition Date Disposition Code Audit Examiner Date Completed Merit Rate Requested Fed. Cert. Requested

(mm/dd/yy)
( ) FEIN: -

PO Box State: Telephone No.: ( ) FEIN:
(

ZIP Code __ __ __ __ __ - __ __ __ __ - __ __ - __
) -

Ext.:

-

PO Box ZIP Code __ __ __ __ __ - __ __ __ __ - __ __ - __
) -

Ext.:

If you sell "substantially all the assets within (Indiana)" but keep the corporation, that is a complete sale (disposition) under Indiana Code 22-4-7-2-a. Explain fully any special circumstances (attach any related legal documents):

I certify that the information contained in this report is true and correct.
( ) -

Authorized Signatu re

Telephone Number

Extension

Date