Form C-36 - Notice Of Change Form - Vermont Department Of Employment & Training
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1VT EMPLOYER NO.
VERMONT DEPARTMENT OF EMPLOYMENT & TRAINING
P.O. BOX 488
MONTPELIER, VERMONT 05601-0488
NOTICE OF CHANGE
PHONE 802-828-4000 FAX (802) 828-4248
C-36 Web Version
FEDERAL ID NUMBER
-
Please complete this section using information as it is currently registered with this Department.
EMPLOYER NAME
MAILING ADDRESS
STREET
TRADE OR DBA NAME (LIST ALL)
CITY
STATE
ZIP CODE
ATTENTION OR C/O NAME
E-MAIL ADDRESS
TELEPHONE NUMBER
FAX NUMBER
Complete all items APPLICABLE to your organization, trade, business or employment in Vermont.
1. Effective on
C. Our Business Was:
o
A. Our Business
Sold (Complete Item #4)
o
o
*1.
No longer has Employees in VT
Leased (Complete Item 4)
o
o
2.
Discontinued Operations in VT
Reorganized (Please explain in Item 5)
o
o
3.
Is Out of Business in Vermont
Foreclosed On
o
* If your business is a Corporation, are your
Filed for Bankruptcy
o
officers receiving any wages or draws AFTER
Other (Please specify in Item 5)
the effective date?
o
o
Yes
No
D. Number of Employees (including Coporate Officers)
B. Our Business Changed to:
Prior to Change:
o
o
Proprietorship
Corporation
Retained by you after change:
o
o
Partnership
Association
o
Limited Liability Company (LLC)
2. Corrections To Name and Address on Form
3. Location (Name and Address)
(No Change in Ownership)
NAME
of All Your Employment Records
ADDRESS
PHONE
4.
A. Enter complete Name, Trade Name, Address
NAME
and Phone Number of New Owners/Operators:
TRADE NAME
ADDRESS
PHONE
o
o
All o Part - If part, show percentage(s) retained by type shown.
Did you retain Title or Control of Any Assets
None
B.
OTHER
Land
Buildings
Inventory
Machinery
Vehicles
Office
Furniture &
Accounts
Franchises
Specify in
Equipment
Fixtures
Receivable
%
%
%
%
%
%
%
%
%
Item 5
o
o
C.
Yes
No
Will you continue to pay wages after the sale/lease of your business?
If yes, for what purpose?
o
o
D.
Yes
No
Will you continue to operate a business under this legal entity?
If yes, give the name and nature of the business retained.
o
o
E.
Yes
No
Will you be starting a new business under this legal entity?
If yes, provide name, nature, and first date wages will be paid.
5. Describe Any Other Changes
6. Contact (Name AND Phone) for Additional Information
I CERTIFY THAT THESE STATEMENTS ARE TRUE AND CORRECT.
SIGNATURE
DATE
TITLE
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