Form De 24 - Notification Of Change Of Employer Account Information
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1NOTIFICATION OF CHANGE OF EMPLOYER ACCOUNT INFORMATION
YOUR ACCOUNT NUMBER
Mail to: Employment Development Department
Account Services Group—MIC 28
Owner’s Name:
P.O. Box 826880
Sacramento, CA 94280-0001
Business Name:
PLEASE INDICATE THE CHANGE(S) TO YOUR BUSINESS BELOW:
A.
Address change only (please provide new mailing address/telephone number below in box 1).
B.
Business discontinued without successor: ____/____/____ (please provide forwarding address below in box 1).
C.
Discontinued paying wages. Last wage payment made on ____/____/____.
D.
Change of business name. New business name:
E.
Change of ownership: Enter exact date ____/____/____ (please provide type of change below in box 2 or 3).
If A or B checked above:
1
STREET AND NUMBER
CITY, STATE, AND ZIP CODE
TELEPHONE NUMBER
If E checked above:
Partial sale only, not out-of-business.
Entire business sold (enter successor name and address below).
Corporation formed.
Partnership to sole (enter sole proprietor’s name below).
Corporation dissolved.
Other (explain):
2
OWNER’S NAME(S) FOLLOWING
BUSINESS NAME
BUSINESS MAILING ADDRESS
CHANGE OF OWNERSHIP
NEW Federal Employer Identification Number
If,
Partner(s) added.
Partner(s) withdrew.
(enter partner information, add or withdrawn, below)
3
PARTNER(S) ADDED/WITHDRAWN
SOCIAL SECURITY NUMBER
DRIVER’S LICENSE NUMBER
REMINDER: If you have discontinued paying wages or have discontinued your business without a successor, you have
ten (10) days to file your final DE 88 with payment, Quarterly Wage and Withholding Report (DE 6), and
Annual Reconciliation Statement (DE 7).
SIGNATURE
FOR DEPARTMENT USE ONLY
TITLE
(
)
ENTERED BY: __________ DATE: ____/____/____
PHONE NO.
DE 24 Rev. 2 (1-03) (INTERNET)
Page 1 of 1
CU
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