Form Uc Cr4 - Employer Change Request - Alabama Department Of Industrial Relations
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1STATE OF ALABAMA
FORM UC CR4
(Rev. 8/03)
DEPARTMENT OF INDUSTRIAL RELATIONS
PAGE 5
UNEMPLOYMENT COMPENSATION DIVISION
MONTGOMERY, ALABAMA 36131
(334) 242-8830
DO NOT COMPLETE THIS PAGE UNLESS THERE HAS BEEN A CHANGE
EMPLOYER CHANGE REQUEST
EMPLOYER ACCOUNT NUMBER AS SHOWN ON C4-4______________________________________________________
EMPLOYER NAME AS SHOWN ON CR-4 __________________________________________________________________
________________________________________________________________
QUARTER ENDING REPORT
If any of the following changes have occurred, complete and return with Page One and Two.
If your business was discontinued by leasing employees or a
1. Current Federal I.D. Number
change in ownership has occurred, complete the following:
2. Corporation Name Change Only. Date: ________________
6. Business discontinued:
Date: _____________
________________________________________________
Sale [ ]
Leased [ ]
3. If your name is incorrect, show correction here.
Explain: ________________________________________
________________________________________________
________________________________________________
4. If your Mailing Address is incorrect, show correction here.
________________________________________________
________________________________________________
________________________________________________
________________________________________________
7. Entire business sold:
Date: _____________
________________________________________________
8. Partial sale only, not out
Date: _____________
________________________________________________
of business:
5. This is for information only, not a mailing address change.
9. Merger:
Date: _____________
If the Principal Location of your business operations in
If Items 7, 8, or 9 indicated, complete Item 10.
Alabama has changed, enter address of new location here.
10. New Owner’s or Leasing Company’s Name and Address:
(Do not use a P.O. Box Number.)
________________________________________________
________________________________________________
________________________________________________
(Street Address)
________________________________________________
________________________________________________
________________________________________________
(City)
(Zip Code)
11. Corporation formed:
Date: _____________
________________________________________________
State:_____________
(County)
(Telephone Number)
________________________________________________
________________________________________________
12: Partners’s added or withdrawn:
Date: _____________
________________________________________________
________________________________________________
This is to certify that the information in this report is true and correct to the best of my knowledge.
Signature:
Title:
Telephone:
Date:
This report must be signed and dated by an authorized person, including their title and telephone number, or changes will not be made.
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Parent category: Business