Form C-1am - Amended Status Report
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1
2Amended Status Report
Mail To:
Cashier - Texas Workforce Commission
P.O. Box 149037
This report should be used to update your account with TWC
Austin, TX 78714-9037
Please complete Items 1 through 8, any other item that needs to
512.463.2731
be updated, and sign the report in Item 20 on the back.
TWC Use Only
County Code
Tax Area
Identification Section
1. Account Number assigned by TWC
5. Federal Employer ID Number
2. Name
6. Area Code/Phone Number
3. Mailing address
7. Address of Records/Payroll
4. City, State, Zip
8. City, State, Zip
9. Owners’ or Officers’ Name
Soc. Sec. No.
Title
Residence Address, City, State
10. Business location(s) in Texas
Trade Name
Street Address, City
Kind of Business
No. Employees
Acquisition Section
11. If you acquired the business in Texas from a previous owner, you must complete Items 11-14.
Mo.
Day
Yr.
Acquisition Date :
Previous Owner’s TWC Account Number (if known):
Previous Owner’s Name:
Previous Owner’s Address:
City, State, Zip:
Portion of business acquired:
All
(check one):
Part (specify)
12. On the date of the acquisition, was the previous owner(s), or any partner(s), officer(s), shareholder(s) or other owner(s) of a legal or
Yes
No
equitable interest of the predecessor business, related by blood or marriage, to you or any of the owners, partners, officers or
shareholders of the successor business?
If “yes”, check all that apply:
Same owner, officer, partner, or shareholder
Same parent company
If other, describe:
Sole proprietor incorporating
Other
13. If “no” on the date of the acquisition, did the previous owner(s), partner(s), officer(s), shareholders(s) or other
Yes
No
owner(s) of a legal or equitable interest hold an option to purchase such an interest in the successor business?
14. After the acquisition, did the predecessor continue to:
Yes
No
•
Own or manage the organization that conducts the organization, trade or business?
•
Yes
No
Own or manage the assets necessary to conduct the organization, trade or business?
•
Control through security or lease arrangement, the assets necessary to conduct the organization, trade or business?
Yes
No
•
Direct the internal affairs or conduct of the organization, trade or business?
Yes
No
If yes to any of above, describe:
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C-1AM (042006)
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