Form K-Cns 020 - Employer'S Notice Of Change
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1Kansas Department of Labor
EMPLOYER’S
401 SW Topeka Blvd
Topeka, KS 66603-3182
NOTICE OF CHANGE
Telephone - 785-296-5027 • • Fax - 785-291-3425
1. Employer Name and Address
2. Account Number
________________________________________________________________
______________________________
Trade Name
________________________________________________________________
3. Date of Change MM/DD/YYYY
Address
________________________________________________________________
______________________________
City, State, Zip+4
4. Reason for Change Use a separate Notice of Change for each successor.
A. Business in Kansas continues in operation without employment
B. Business in Kansas suspended or entirely discontinued without successor
C. Business in Kansas acquired in whole or part by successor(s)
5. Successor Identification
________________________________________________
________________________________________________
Trade Name
Owner/Partner/Principal Officer
________________________________________________
________________________________________________
Address
Daytime Telephone Number
________________________________________________
________________________________________________
City, State, Zip+4
Successor’s Kansas UI Account Number or FEIN
Did the successor acquire or in any manner succeed to the following?
YES
*NO
Substantially all of the employing enterprises, organization, trade or business.
OR
YES
*NO
Substantially all of the assets
* If NO, explain what portion the successor acquired and what portion you kept. Use additional sheets if required.
6. Organization with same principals as before, with the form changed to
Individual (Sole Proprietor)
Limited Partnership
Corporation
Partnership
Limited Liability Partnership
Limited Liability Company
Other (Explain)___________________________________________________________________________________
7. Was this a change only in partners?
*YES
NO
*If YES, indicate
Withdrawal
Addition
Substitution
Death of Partner
Former Partner’s Name________________________________ New Partner’s Name_________________________________
We continue to report to IRS with the same FEIN
YES
NO
FEIN ________________________________
__________________________________________________ ________________________________ ______________
Signature/Name
Title
Date Signed
K-CNS 020 (Rev. 9-04)
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