Form UC-247 "Application and Agreement for Severable Portion Experience Rating Transfer" - Arizona

What Is Form UC-247?

This is a legal form that was released by the Arizona Department of Economic Security - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2006;
  • The latest edition provided by the Arizona Department of Economic Security;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form UC-247 by clicking the link below or browse more documents and templates provided by the Arizona Department of Economic Security.

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Download Form UC-247 "Application and Agreement for Severable Portion Experience Rating Transfer" - Arizona

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Form SPT-UC-247
Application and Agreement for Severable
Portion Experience Rating Transfer
If you purchased part of an existing business (and checked the “Part” box in Section VI of your
Arizona Joint Tax Application, Form UC-001), you may apply for a portion of the prior owner’s
unemployment tax rate. Use this form to make application for this severable portion within 180
. Your completed form should be mailed or faxed to the address or fax
DAYS OF THE ACQUISITION
number shown below.
-
,
REMEMBER
WHEN YOU PURCHASE A BUSINESS
THE SEVERABLE PORTION
.
IS NOT AUTOMATICALLY ASSIGNED
.
180 DAYS OF THE ACQUISITION
YOU MUST APPLY FOR IT WITHIN
Questions about completion of this form or severable portions may be directed to the
Experience Rating Unit at
Experience Rating Unit
ADES – UI Tax Section
P. O. Box 6028
Phoenix, AZ 85005-6028
Telephone - (602) 248-9101
(602) 771-6603
Extension 5501
FAX - (602) 277-3404
532-5564
Form SPT-UC-247
Application and Agreement for Severable
Portion Experience Rating Transfer
If you purchased part of an existing business (and checked the “Part” box in Section VI of your
Arizona Joint Tax Application, Form UC-001), you may apply for a portion of the prior owner’s
unemployment tax rate. Use this form to make application for this severable portion within 180
. Your completed form should be mailed or faxed to the address or fax
DAYS OF THE ACQUISITION
number shown below.
-
,
REMEMBER
WHEN YOU PURCHASE A BUSINESS
THE SEVERABLE PORTION
.
IS NOT AUTOMATICALLY ASSIGNED
.
180 DAYS OF THE ACQUISITION
YOU MUST APPLY FOR IT WITHIN
Questions about completion of this form or severable portions may be directed to the
Experience Rating Unit at
Experience Rating Unit
ADES – UI Tax Section
P. O. Box 6028
Phoenix, AZ 85005-6028
Telephone - (602) 248-9101
(602) 771-6603
Extension 5501
FAX - (602) 277-3404
532-5564
UC-247 (8/99)
UC-247 (10/06)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Unemployment Tax- Experience Rating - 911B
602-771-6603 FAX 602-532-5564
PO Box 6028; Phoenix, Arizona 85005-6028; Phone: 602-248-9101 Ext. 5501
E-Mail: uit.experience@azdes.gov
APPLICATION AND AGREEMENT FOR SEVERABLE PORTION EXPERIENCE RATING TRANSFER
THIS APPLICATION MUST BE FILED WITHIN 180 DAYS OF THE DATE OF ACQUISITION
PREDECESSOR EMPLOYER NAME
SUCCESSOR EMPLOYER NAME
!
!
business
1. Did the successor employer continue to operate the acquired portion of the
Yes
No
Effective date of transfer:
2. Enter the TAXABLE wages paid in the last 12 completed calendar quarters preceding the date of acquisition (or for the
period of existence of the business if less than 12 quarters) AND, if the business was acquired in the middle of a
quarter, the wages for the portion of the quarter up to the date of acquisition. List wages by quarter and include:
Column (1) Taxable wages for the retained and transferred portions of the business combined.
Column (2) Taxable wages attributable to the portion of the business retained by the predecessor.
Column (3) Taxable wages attributable to the portion of the business transferred to the successor.
Column 2 plus Column 3 must equal Column 1. NOTE: If the predecessor acquired another business within the
applicable 12 calendar quarters, include the taxable wages from that business. Any corrections submitted after original
reports were filed must also be included.
THE TRANSFER OF A SEVERABLE PORTION OF THE EXPERIENCE RATING ACCOUNT IS NOT MANDATORY
COLUMN 1
COLUMN 2
COLUMN 3
QUARTER ENDING
TAXABLE WAGES
TAXABLE WAGES
TAXABLE WAGES
BOTH PORTIONS
PREDECESSOR PORTION
SUCCESSOR PORTION
TOTAL
3. The undersigned agree to the transfer of the predecessor's experience rating account applicable to the distinct and
severable portion of the business acquired by the successor. It is further understood that if all requirements are met:
(1) the amount of the experience rating account transferred will be a percentage of the predecessor's total experience
rating account;
(2) both parties shall receive copies of the predecessor's Benefit Charge Notices, and each shall be subject to its
proportionate share of charges for three fiscal years; and
(3) the predecessor may be required to submit amended wage reports for the quarter in which the transfer occurred.
PREDECESSOR EMPLOYER NAME
SUCCESSOR EMPLOYER NAME
ADDRESS
ADDRESS
ACCOUNT NO.
PHONE NO.
ACCOUNT NO. OR FEDERAL I.D.
PHONE NO.
SIGNATURE OF OWNER/PARTNER/CORPORATION OFFICER
SIGNATURE OF OWNER/PARTNER/CORPORATION OFFICER
TITLE
DATE
TITLE
DATE
Equal Opportunity Employer/Program
For alternative format/reasonable accommodations: contact the UI Tax Office
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