Wyoming Employer'S Notice Of Change Form
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1WY0MING EMPLOYER’S NOTICE OF CHANGE
Use this document to report changes of address, name, telephone number; addition or change of federal ID number;
change of account status; sale of a portion or all of the business. Complete all sections that apply by marking the
appropriate choice and providing information as requested, date and sign below. Attach documentation as needed.
UI Number:
WC Number:
FEIN:
CHANGE IN NAME, ADDRESS AND/OR FEDERAL IDENTIFICATION NUMBER:
Mailing Address for Tax Info:
Mailing Address for Benefit Info:
n
Effective Date of Change
n
Legal Name Changed To
Physical Location:
Telephone Number:
n
Business Name Changed To
n
Federal IRS/Employer Identification (FEIN)
Changed To
Additional Location(s) added (Provide Full name & address)
Reason For Change
Attach List if Necessary
REQUEST ACCOUNT BE PLACED IN INACTIVE STATUS:
BANKRUPTCY INFORMATION:
n
Closed Business. Date last wages paid
Bankruptcy Petition #:
Petition date:
n
Sold, merged, leased or otherwise transferred entire business.
Chapter #:
Judicial District:
Use change in ownership section below.
Attorney Name:
n
Operating without employees. Date last wages paid
Address:
(Note: corporate officer salaries are wages and are taxable)
Telephone #:
CHANGE IN OWNERSHIP - INCLUDES SALE, MERGER, TRANSFER, LEASE:
n
Sold, leased or transferred PART of business
Date of Sale:
Seller’s last day of payroll:
n
Sold, leased or transferred ALL of business
Acquiring party’s name, address, phone number:
Does Seller retain some business with payroll?
Portion of business sold-identify location &
assets
Return to:
Employment Tax Division
Employer Services
P.O. Box 2760
Casper WY 82602-2760
Signature
Title
Phone#
Date
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Parent category: Financial