Form UC-514 Report of Changes Form - Arizona

Form UC-514 or the "Report Of Changes Form" is a form issued by the Arizona Department of Economic Security.

Download a PDF version of the Form UC-514 down below or find it on the Arizona Department of Economic Security Forms website.

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ARIZONA DEPARTMENT OF ECONOMIC SECURITY
UC-514 (03-18)
Employer Engagement Administration
REPORT OF CHANGES FORM
The Report of Changes form is used to advise the Arizona Department of Economic Security of any modifications to
your business OPERATION or STRUCTURE. You must promptly report any changes in OWNERSHIP, LEGAL FORM,
OPERATION, PAYROLL METHOD, or ADDRESS of your business. Failure to do so may result in additional costs to
you later.
Your completed form should be mailed or faxed to the address or fax number shown below.
Questions about completing the Report of Changes form or how modifications to your business may affect your UI tax
account should be directed to the Employer Registration Unit at:
Employer Registration Unit
P.O. Box 6028 • Mail Drop 5881
Phoenix, Arizona 85005-6028
Telephone: (602) 771-6602
Fax: (602) 532-5539
Email
uitstatus@azdes.gov
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the
Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination
Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits
discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national
origin, age, disability, genetics and retaliation. The Department must make a reasonable accommodation to allow a
person with a disability to take part in a program, service, or activity. Auxiliary aids and services are available upon
request to individuals with disabilities. To request this document in alternative format or for further information about
this policy, Contact the UI Tax Office at 602-771-6606; TTY/TDD Services: 7-1-1. • Free language assistance for DES
services is available upon request.
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
UC-514 (03-18)
Employer Engagement Administration
REPORT OF CHANGES FORM
The Report of Changes form is used to advise the Arizona Department of Economic Security of any modifications to
your business OPERATION or STRUCTURE. You must promptly report any changes in OWNERSHIP, LEGAL FORM,
OPERATION, PAYROLL METHOD, or ADDRESS of your business. Failure to do so may result in additional costs to
you later.
Your completed form should be mailed or faxed to the address or fax number shown below.
Questions about completing the Report of Changes form or how modifications to your business may affect your UI tax
account should be directed to the Employer Registration Unit at:
Employer Registration Unit
P.O. Box 6028 • Mail Drop 5881
Phoenix, Arizona 85005-6028
Telephone: (602) 771-6602
Fax: (602) 532-5539
Email
uitstatus@azdes.gov
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the
Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination
Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits
discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national
origin, age, disability, genetics and retaliation. The Department must make a reasonable accommodation to allow a
person with a disability to take part in a program, service, or activity. Auxiliary aids and services are available upon
request to individuals with disabilities. To request this document in alternative format or for further information about
this policy, Contact the UI Tax Office at 602-771-6606; TTY/TDD Services: 7-1-1. • Free language assistance for DES
services is available upon request.
REPORT OF CHANGES
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
UC-514 (03-18)
P.O. Box 6028 • Mail Drop 5881 • Phoenix, AZ 85005-6028
ARIZONA ACCOUNT NUMBER
Telephone (602) 771-6602 • Fax (602) 532 5539
Report ANY CHANGES PROMPTLY (ownership, legal form, operation, payroll
method, or address of your business) as required by Arizona Administrative
FEDERAL ID NUMBER
Code R6-3-1703. Failure to do so could result in additional cost to you later.:
A.
Change in Mailing Address
NEW ADDRESS (No., Street, or P.O. Box)
MAIL NOTICE OF UNEMPLOYMENT CLAIMS TO (No., Street, or P.O. Box)
CITY, STATE, ZIP CODE
CITY, STATE, ZIP CODE
PHONE NUMBER
PHONE NUMBER
B.
Change in the Business’ Email Address
Change in Sides E-Response Email Address
EMAIL
EMAIL
C.
Change in Arizona Ownership / Operation
All of the Arizona business was transferred to (complete item 1 below), as of
(date)
Part of the Arizona business was transferred to (complete items 1 and 2 below), as of
(date)
In the portion of business transferred, did you during the current or preceding calendar year: 1) Employ one or more
individuals for a part of a day in at least 20 weeks, or pay $1,500 or more in wages in a calendar quarter, OR 2) If the
business is agricultural, did you employ 10 or more individuals for a part of a day in at least 20 weeks, or pay $20,000
or more wages in a calendar quarter?
Yes
No
No ownership change occurred, but payroll is paid by (complete item 1 below), as of
(date)
No ownership change occurred, but leasing employees (complete item 1 below), as of
(date)
AZ Business was discontinued without being sold, leased or transferred, as of
(date)
Business is operating in Arizona, but ceased paying wages, as of
(date)
ITEM 1
NAME OF NEW OWNER, PARTNERSHIP, CORPORATION, PAYROLLER, LEASING COMPANY
PHONE NUMBER
ADDRESS (No., Street, P.O. Box, City, State, ZIP Code)
ARIZONA ACCOUNT NUMBER
ITEM 2
NAME OF BUSINESS YOU RETAINED
PHONE NUMBER
ADDRESS (No., Street, P.O. Box, City, State, ZIP Code)
D.
SIGNATURE AND TITLE OF OWNER, PARTNER, CORPORATE OFFICER OR AGENT
DATE
MAILING OR FORWARDING ADDRESS (No., Street, P.O. Box, City, State, ZIP Code)
PHONE NUMBER
FOR AGENCY USE ONLY
Change of owner
Inactive
Comments
Merge into
Suspend
Transfer to
Established in Error
Revise close code
Terminate
Close date
Initial
Date
See reverse for EOE/ADA/LEP/GINA disclosures

Download Form UC-514 Report of Changes Form - Arizona

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