UI-50A (Rev. 11/17)
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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