Form Wyo-015 - Wyoming Employer'S Notice Of Change
ADVERTISEMENT
1WYOMING EMPLOYER’S NOTICE OF CHANGE
WYO -015 (4/16)
Use these documents to report changes of address, name, telephone number, addition or change of
federal ID number, change of account status or sale of a portion or all of the business. Complete all
sections that apply by marking the appropriate choice and providing ALL information as requested in
particular section, date and sign below.
Please do not send the form if there are no changes.
Attach documentation as needed.
Unemployment Insurance Number:
Worker’s Compensation Number:
IRS Tax ID (FEIN):
CHANGE IN NAME AND /OR FEDERAL IDENTIFICATION NUMBER:
Effective Date of Change:
Legal Name Changed To:
Federal IRS/Employer Identification (FEIN)
Business Name Changed To:
Changed to:
Reason for change
Change in Entity Yes
No
CHANGE IN ADDRESS:
Effective Date of Change:
Physical Address (Attach list if more than one location):
Telephone Number:
Unemployment Mailing Address for Tax Info:
Worker Compensation Mailing Address for Tax Info (WC only
summary reports):
Unemployment Mailing Address for Benefit Info:
Workers Compensation for General and Claims Info:
REQUEST TO CLOSE ACCOUNT:
BANKRUPTCY INFORMATION:
Closed Business. Date Last Wages Paid:
Bankruptcy Petition #:
Operating Without Employees.
Petition Date
Date Last Wages Paid:
Chapter #:
Judicial District:
If a Corporation or Limited Liability Company, does the
Attorney Name:
corporation or LLC continue to operate in Wyoming?
Address:
Yes
No
Will corporate officers/owners who reside in Wyoming
Telephone#:
continue to receive any form of compensation?
Yes
No
CHANGE IN OWNERSHIP-INCLUDES SALE, MERGER, TRANSFER, LEASE:
Sold, Leased, or Transferred
Date of Sale:
Seller’s Last Day of Payroll:
PART of Business
ALL of Business
Does Seller Retain Some Business with Payroll?
Acquiring Party’s Name, Address, and Phone Number:
Percentage of Business Sold:
(identify location & assets)
Stock Sale only
Yes No
Printed Name
Signature
Date
Title
_
Phone Number
Return this form to:
Email Address
Wyoming Department of Workforce Services –
Registration Unit
PO Box 2760
Casper, WY 82602
Phone (307) 235-3217
Fax (307) 235-3278
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal