1025 Uia UC1025 76085 7
User Manual: 1025
Open the PDF directly: View PDF 
.
Page Count: 1
| Download | |
| Open PDF In Browser | View PDF |
UIA 1025 (Rev. 09-17) Authorized by MCL 421.1 et seq. RESET FORM STATE OF MICHIGAN DEPARTMENT OF TALENT AND ECONOMIC DEVELOPMENT RICK SNYDER GOVERNOR ROGER CURTIS TALENT INVESTMENT AGENCY • DIRECTOR UNEMPLOYMENT INSURANCE WANDA M. STOKES DIRECTOR Employer Request for Name/Address Change Current or Former Employer Name:_______________________________________________ UI Employer Account No.:_______________ Federal Employer ID No. (FEIN):________________ New Employer Name:_______________________________________________________________ DBA:____________________________________________________________________________ E-Mail Address:____________________________________________________________________ DO NOT SUBMIT THIS FORM UNLESS THERE HAS BEEN A CHANGE IN NAME AND/OR ADDRESS.* Physical Michigan Location of the Business (No Post Office Boxes) Street Address 1: City Street Address 1: State Zip Code Street Address 2: City Mailing Address City State Zip Code State Zip Code Street Address 2: State Zip Code Employer's Telephone Number: City Mailing Address belongs to: Corporate Office Owner * The Power of Attorney on file is responsible for all mailing to a representative. The address of a representative should not be on this name/address form. CHANGING ACCOUNT INFORMATION: If you have discontinued or ceased business activity, discontinued employment, sold or transferred ownership of all or part of your business, formed a new partnership or corporation, merged, or changed your status as a sole proprietorship or corporation, you must file Form UIA 1772, Notice of Change You may submit Form UIA 1772 through your MiWAM account or you may download and print the form, and mail the completed address shown below. You can also access your MiWAM account to change your address and other account information. Other changes, including FEIN changes or bankruptcy filing, etc., must be submitted in writing with supporting documentation. YOU MUST sign and date this form, giving your title and telephone number, before changes will be accepted. Preparer:________________________________ Date:_________________ Title:___________________________________ Preparer Telephone No.: _______________________ Mail this form with your changes and documentation to: Unemployment Insurance, PO Box 8086, Royal Oak, MI 48086, or fax to (313) 456-2130. If you need assistance, telephone 1-855-484-2636. TTY customers call 1-866-366-0004. TED is an equal opportunity employer/program.
Source Exif Data:
File Type : PDF File Type Extension : pdf MIME Type : application/pdf PDF Version : 1.6 Linearized : Yes Encryption : Standard V4.4 (128-bit) User Access : Print, Fill forms, Extract, Print high-res Create Date : 2016:08:05 11:22:10-04:00 Creator : Adobe InDesign CS6 (Windows) Modify Date : 2018:01:08 09:40:50-05:00 Has XFA : No Tagged PDF : Yes XMP Toolkit : Adobe XMP Core 5.2-c001 63.139439, 2010/09/27-13:37:26 Metadata Date : 2018:01:08 09:40:50-05:00 Creator Tool : Adobe InDesign CS6 (Windows) Instance ID : uuid:589f6ef6-317d-466b-9786-3874f977cc2c Original Document ID : xmp.did:A0BB251DE970E0119F3CBEC32D84F4D0 Document ID : xmp.id:4F301950205BE6118B83E47D0C0F19A4 Rendition Class : proof:pdf Derived From Instance ID : xmp.iid:4E301950205BE6118B83E47D0C0F19A4 Derived From Document ID : xmp.did:1B1F6B4D1F5BE6118B83E47D0C0F19A4 Derived From Original Document ID: xmp.did:A0BB251DE970E0119F3CBEC32D84F4D0 Derived From Rendition Class : default History Action : converted History Parameters : from application/x-indesign to application/pdf History Software Agent : Adobe InDesign CS6 (Windows) History Changed : / History When : 2016:08:05 11:22:10-04:00 Format : application/pdf Producer : Adobe PDF Library 10.0.1 Trapped : False Version : 1.1 State : 1 Page Count : 1EXIF Metadata provided by EXIF.tools