Fillable EMPLOYER CHANGE REQUEST (Colorado DORA)

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EMPLOYER CHANGE REQUEST (Colorado DORA)

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The EMPLOYER CHANGE REQUEST (Colorado DORA) form is 1 page long and contains:

  • 1 signature
  • 19 check-boxes
  • 34 other fields

Country of origin: US
File type: PDF

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Colorado Department of Regulatory Agencies (DORA) is responsible for professional licensing and consumer protection in Colorado USA.

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UITL-2 (R 08/2010)
Colorado Department of Labor and Employment
Unemployment Insurance Employer Services
P.O. Box 8789, Denver, CO 80201-8789
303-318-9100 (Denver-metro area) or
1-800-480-8299 (outside Denver-metro area)
www.colorado.gov/cdle/ui
EMPLOYER CHANGE REQUEST
Please type or use black ink and return to the above address. Instructions are on page 2. If you have any questions, call one of the above
telephone numbers.
PART I—EMPLOYER INFORMATION. All information in Part I must be completed by the person making the change request.
Owner, Partners, or Corporate Name
Employer Account Number
Trade Name
Street Address
City State ZIP Code
PRIOR INFORMATION
The form must be signed in Part IV; if this form is not signed, it cannot be processed.
PART II—CHANGE OF OWNERSHIP/TERMINATION OF BUSINESS OR EMPLOYMENT
Sole proprietorship or partnership incorporating are considered as new businesses. Change of ownership includes changing 50
percent or more in a partnership.
NOTE: Do not complete this form if you a
re only transferring corporate stock.
1. Date of termination or change: _______/______/______. b. Date employer in Part I last paid wages:____/____/_____.
2. Did the employer in Part I have seasonal status with the Division? Yes No
3. Reason for change or termination:
a. Business closed e. Partial sale of business (Contact the g. Incorporation
h. Merger b. No paid employees
(Include corporate officers)
c. Consider workers to be contract
labor
d. Sale of entire business (All
locations)
Department for information concerning
partial transfer of experience rate to the
buyer)
f. All employees being reported by
employee leasing company or
management company
Name:
Account Number:
i. Other _____________
__________________
4. a. Will the employer in Part I continue to have employees in Colorado? Yes No
b. If boxes d, e, f, g, h, or i are checked above, the new employer listed below must complete Form UITL-100, Application for
Unemployment Insurance Account and Determination of Employer Liability.
1. Name of new employer ________________________________________________________________________________
2. Tr
ade name of new employer ___________________________________________________________________________
3. A
ddress of new employer ______________________________________________________________________________
c. If partial sale, were any employees transferred from the employer in Part I to the new employer listed above? Yes No
If Yes, 1. How many employees were transferred? ___________________________
2. List the total number of employees in your entire business in each of your four
pay periods preceding the date of sale.
This includes all employees in the portion sold and all employees in the portion retained.
_
_____________________ ____________________ _____________________ ____________________
PART III—CHANGE OF NAME OR ADDRESS ONLY (Must also complete Part I with previous address)
If this is a change of address, this change is for: Physical location address Mailing address for ALL premium information
Mailing address for all benefits information Trade name change
New Partner(s), Corporate Name (If a corporate name change, include a copy of the Certificate of Amendment)
New Trade Name
New In Care of Name (if applicable)
Telephone Number
NEW INFORMATION
New Street
City State ZIP Code
PART IV—CERTIFICATION OF CHANGE
I certify that I am authorized to make this report and the information is correct.
Signature Date
REQUIRED
INFORMATION
Title
Telephone Number
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UITL-2 Page 2 (R 08/2010)
INSTRUCTIONS FOR COMPLETING THE EMPLOYER CHANGE REQUEST
Requirements for completing the form:
1. All information in Part I must be completed.
2. Co
mplete Part II if there is a change in the business ownership or termination of business.
3. Co
mplete Part III if there is a change in the mailing address.
4. Part IV
must be signed for any change to be made.
NOTE: If there are distribution points assigned for the business, complete a separate form for each distribution point
account number to be changed.
Instructions for completing this form:
PART I—EMPLOYER INFORMATION
1. Owner, partners, or corporate name–the entity (owner) name.
2. Account number
—The Colorado unemployment insurance (UI) account number is required.
3. Trade na
me
—The name the business is “doing business as.”
4. Street addres
s, city, state, and ZIP code
—The current mailing address of the business that is on record for
Colorado UI purposes.
PART II—CHANGE OF OWNERSHIP/TERMINATION OF BUSINESS OR EMPLOYMENT
1. The date the business was sold or closed.
2. The date the last wage
s were paid to any employees by the employer in Part I.
3. Indicate if business in
Part I was designated as a seasonal employer by UI Employer Services.
4. Check the rea
son
NOTE: If a change in the interest of a partnership is less than 50 percent, there will not be an entity
change, only
a name change (see Part III).
5. Co
mplete for the sale of all or any part of the business, transfer of employees to an employee leasing/management
company, incorporation, or merger.
• Be sure to include the name and address of the new em
ployer.
• If this is a partial sale of the business, list how m
any employees were transferred to the new employer.
6. Form UITR-14, Application for Partial Transfer of Experi
ence, must be filed within sixty (60) days after the
notice of employer liability is mailed to the successor employer. A partial transfer of experience will be made if
the criteria for a segregable unit as defined by the Colorado Employment Security Act 8-76-104 (5)(g) is met.
PART III—CHANGE OF NAME OR ADDRESS ONLY
NOTE: To make any address change, all information must be completed in Part I.
1. Mark the appropriate box or boxes to change the mailing address for UI information and/or UI benefits
information. The address change cannot be made without this information.
2. New, partner(s), or corporate name change
—If a partnership, print the names of all partners of the business, not
just the changes. If a corporate name change, be sure to include a copy of the Certificate of Amendment from the
Secretary of State.
3. Co
mplete if there is a change, addition, or deletion of trade name.
4. Address
—Include the complete mailing address for the business, not just the change.
PART IV—CERTIFICATION OF CHANGE
1. Signature—The signature of the person requesting the change to the UI account.
2. Title
—The title of the person requesting the change to the account (e.g., owner, corporate secretary, or employer
representative).
3. Phone
—The phone number to call if any additional information is required.
4. Date—The date the form is completed.
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EMPLOYER CHANGE REQUEST (Colorado DORA)

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Completed 27 January 2021

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