Free 46800.pdf - Indiana


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REPORT OF INACTIVATION
State Form 46800 (R3 / 5-06) INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT 10 N SENATE AVE RM SE106 INDIANAPOLIS IN 46204-2277 Local: 317-232-7436 Toll Free: 1-800-891-6499 Fax: 317-233-2706

FOR OFFICE USE ONLY
Effective Date Audit Examiner Date Completed Refund Requested FILE

Please type or print in ink. Must be completed and returned within ten (10) days. This form must be filed within 30 days of dissolution or liquidation of business. Reference Indiana Code 22-4-32-23(b). Placing an account on `Inactive Status' will not relieve the owner of any debts owed to the State of Indiana. This report must be filed if: (check one) You or your business discontinued operations in Indiana. Your organization is operating without employees in Indiana.

NOTE: If you have sold, leased, or merged all Indiana assets into another company, you need to complete State Form
46799, `Report of Transfer - Complete Sale.'

Indiana SUTA No.: Legal Name of Employing Unit d/b/a Business Address City Date of last payroll:
month day year

(

)

FEIN:

-

State

ZIP Code

-

ALL REPORTS AND CONTRIBUTIONS ARE IMMEDIATELY DUE AND PAYABLE UPON CESSATION OR DISPOSITION OF BUSINESS. REFERENCE 640 IAC 3-1-6.

If there is a different mailing address from the business address listed above, please indicate: Current mailing address City Contact person Phone No. ( ) Ext. State ZIP Code -

I certify that the information contained in this notice is true and correct. (
Authorized Signature

)

Date

Phone Number