Colorado Department of Labor and Employment                                                                                                                                303-318-9100 (Denver-metro area) or 
Unemployment Insurance Employer Services                                                                                                                            1-800-480-8299 (outside Denver-metro area) 
P.O. Box 8789, Denver, CO  80201-8789                                                                                                                                         www.colorado.gov/cdle/ui 
                                                                                                         EMPLOYER  CHANGE  REQUEST 
Please type or use black ink and return to the above address.  Instructions are on page 2.  If you have any questions, call one of the above 
telephone numbers. 
                   
                                                                PART  I—EMPLOYER  INFORMATION   . All information in Part I must be completed by the person making the change request. 
                                                                Owner, Partners, or Corporate Name                                                                  Employer Account Number 
                                                                 
                                                                Trade Name 
                                                                 
                                                                Street Address                                                    City                              State             ZIP Code
                                                                 
                                                                                        The form must be signed inPart IV       ; if this form is not signed, it cannot be processed. 
                  PRIOR INFORMATION 
                                                                PART II—CHANGE  OF  OWNERSHIP/TERMINATION  OF  BUSINESS  OR  EMPLOYMENT 
                                                                Sole  proprietorship or  partnership incorporating are considered as  new businesses.   Change  of  ownership includes changing  50 
                                                                percent or more in a partnership. 
                                                                 
                                                                NOTE:  Do not complete this form if you are only transferring corporate stock. 
                                                                1.  Date of termination or change: _______/______/______.                 b. Date employer in Part I last paid wages:____/____/_____. 
                                                                2.  Did the employer in Part I have seasonal status with the Division?          Yes                 No 
                                                                3.  Reason for change or termination: 
                                                                       a.  Business closed                               e.  Partial sale of business (Contact the             g.  Incorporation 
                                                                       b.  No paid employees                         Department for information concerning                     h.  Merger 
                                                                            (Include corporate officers)              partial transfer of experience rate to the               i.  Other _____________ 
                                                                       c.  Consider workers to be contract            buyer)                                                         __________________ 
                                                                                labor                                    f.  All employees being reported by 
                                                                       d.  Sale of entire business (All              employee leasing company or  
                                                                            locations)                               management company 
                                                                                                                             Name:        
                                                                                                                             Account Number:         
                                                                4.  a. Will the employer in Part I continue to have employees in Colorado?              Yes         No 
                                                                 b. If boxes d, e, f, g, h, or i are checked above, the new employer listed below must complete Form UITL-100, Application for 
                                                                Unemployment Insurance Account and Determination of Employer Liability. 
                                                                      1.     Name of new employer ________________________________________________________________________________ 
                                                                      2.     Trade name of new employer ___________________________________________________________________________ 
                                                                      3.     Address of new employer ______________________________________________________________________________ 
                                    NEW INFORMATION              c. If partial sale, were any employees transferred from the employer in Part I to the new employer listed above?          Yes    No 
                                                                          If Yes,  1. How many employees were transferred? ___________________________ 
                                                                                2. List the total number of employees in your entire business in each of your four pay periods preceding the date of sale.  
                                                                                This includes all employees in the portion sold and all employees in the portion retained. 
                                                                                ______________________     ____________________     _____________________     ____________________ 
                                                                PART III—CHANGE  OF  NAME  OR  ADDRESS  ONLY (Must also complete                       Part I with previous address)  
                                                                If this is a change of address, this change is for:      Physical location address      Mailing address for ALL premium information 
                                                                                             Mailing address for all benefits information                           Trade name change 
                                                                New Partner(s), Corporate Name (If a corporate name change, include a copy of the Certificate of Amendment) 
                                                                 
                                                                New Trade Name 
                                                                 
                                                                New In Care of Name (if applicable)                                                                Telephone Number 
                                                                                                                                                                    
                                                                New Street                                                      City                               State              ZIP Code
                                                                 
                                                                PART IV—CERTIFICATION  OF  CHANGE 
                                                                I certify that I am authorized to make this report and the information is correct. 
                                                                Signature                                                                                                Date 
                                                                                                                                                                          
         REQUIRED                                               Title                                                                                                    Telephone Number 
                                                    INFORMATION 
                                                                 
UITL-2 (R 08/2010) 
                                                                                                                                                                   Clear Form             Save Form

        INSTRUCTIONS  FOR  COMPLETING  THE  EMPLOYER  CHANGE  REQUEST 
                                                                 
Requirements for completing the form: 
 
 1. All information in     Part I must be completed. 
 2. Complete     Part II   if there is a change in the business ownership or termination of business. 
 3. Complete     Part III   if there is a change in the mailing address. 
 4. Part IV must be signed for any change to be made. 
  
 NOTE:  If there are distribution points assigned for the business, complete a separate form for each distribution point 
 account number to be changed. 
  
Instructions for completing this form     :
 
PART  I—EMPLOYER  INFORMATION 
 
 1. Owner, partners, or corporate name–the entity (owner) name. 
 2. Account number        —The Colorado unemployment insurance (UI) account number is required. 
 3. Trade name    —The name the business is “doing business as.” 
 4. Street address, city, state, and ZIP code       —The current  mailing address of the business that is on record for 
    Colorado UI purposes. 
  
PART  II—    CHANGE  OF  OWNERSHIP/TERMINATION  OF  BUSINESS  OR  EMPLOYMENT 
 
 1. The date the business was sold or closed. 
 2. The date the last wages were paid to any employees by the employer in        Part I. 
 3. Indicate if business in    Part I   was designated as a seasonal employer by UI Employer Services. 
 4. Check the reason 
    NOTE:  If a change in the interest of a partnership is less than 50 percent, there will not be an entity change, only 
    a name change (see Part III). 
 5. Complete for the sale of all or any part of the business, transfer of employees to an employee leasing/management 
    company, incorporation, or merger. 
         •       Be sure to include the name and address of the new employer. 
         •       If this is a partial sale of the business, list how many employees were transferred to the new employer. 
 6. Form UITR-14, Application for Partial Transfer of Experience,  must be filed within sixty (60) days after the 
    notice of employer liability is mailed to the successor employer.  A partial transfer of experience will be made if 
    the criteria for a segregable unit as defined by the Colorado Employment Security Act 8-76-104 (5)(g) is met. 
 
PART  III—CHANGE  OF  NAME  OR  ADDRESS  ONLY 
 
    NOTE:  To make any address change, all information must be completed in Part I. 
 
 1. Mark the appropriate box or  boxes to change the  mailing address for UI information and/or UI  benefits 
    information.  The address change cannot be made without this information. 
 2. New, partner(s), or corporate name change       —If a partnership, print the names of all partners of the business, not 
    just the changes.  If a corporate name change, be sure to include a copy of the Certificate of Amendment from the 
    Secretary of State. 
 3. Complete if there is a change, addition, or deletion of trade name. 
 4. Address      —Include the complete mailing address for the business, not just the change. 
  
PART  IV—CERTIFICATION  OF  CHANGE 
 
 1. Signature    —The signature of the person requesting the change to the UI account. 
 2. Title    —The title of the person requesting the change to the account (e.g., owner, corporate secretary, or employer 
    representative). 
 3. Phone    —The phone number to call if any additional information is required. 
 4. Date—The date the form is completed. 
 
UITL-2 Page 2 (R 08/2010)