Mail To 
Cashier - Texas Workforce Commission 
P.O. Box 149037 
Austin, TX 78714-9037 
512.463.2731 
www.texasworkforce.org 
 
                       JOINT APPLICATION FOR PARTIAL TRANSFER OF COMPENSATION EXPERIENCE 
 
Name and Account Number of Successor Employer (New Owner)                                                                                                                 
 
Name and Account Number of Predecessor Employer (Previous Owner)                                                                                                          
 
The successor employer named above, having acquired a part of the organization, trade, or business of the predecessor employer 
named above, does hereby jointly with said predecessor make application to the Texas Workforce Commission under Chapter 204, 
Subchapter E Section 204.084 of the Texas Unemployment Compensation Act for that compensation experience of said predecessor, 
which is attributable to the part of the organization, trade, or business acquired, to be treated as compensation experience of said successor. 
 
We, the joint applicants, submit the following information and the attached Form C-83 (Wage Report Section) in support of our 
application and as a basis for the Commission's finding: 
 
1. Immediately prior to                             , the date of acquisition, the predecessor operated the following businesses or part 
    of a business and no others: (Attach supplemental sheet, if more space is needed.) 
 
                                                                                                             Each First Wages Paid Date by 
                       Each Trade Name and Location                         Nature of Business                                    Predecessor Division 
                                                                                                                        
2. The successor acquired from the predecessor and immediately after the acquisition continued to operate the following businesses 
    or part of a business, the compensation experience attributable to which is identifiable and segregable from the total 
    compensation experience of the predecessor: (Attach supplemental sheet, if more space is needed.) 
 
                                                                                                             Each First Wages Paid Date by 
                       Each Trade Name and Location                          Date Acquired                                        Successor 
                                                                                                                        
3. The successor made the following changes, if any, in trade name, location or nature of business: 
 
4.     Waiver of Predecessor’s Rights: The predecessor does hereby forever waive his rights to an experience rating based on the 
       compensation experience attributable to the part of the organization, trade, or business acquired by the successor and agrees to 
       transfer such compensation experience to the successor. 
 
5.  I hereby confirm that the statements made and the information given with respect to the predecessor employer in this Joint     
       Application for Partial Transfer of Compensation Experience and on the attached Form (C–83) are true and correct and that I 
       execute the above waiver with full knowledge of its effect. 
    
      (Predecessor’s Signature: owner, partner or officer and Date) 
 
6.  I hereby confirm that the statements made and the information given with respect to the successor employing unit in this Joint 
       Application for Partial Transfer of Compensation Experience and on the attached Form (C–83) are true and correct. 
    
     (Successor’s Signature: owner, partner or officer and Date) 
 
                                                               IMPORTANT 
                                     Please read carefully Item 4 on this application regarding “Waiver of Predecessor’s Rights”. 
                                                                        
                Individuals may receive, review and correct information that TWC collects about the individual by emailing to open.records@twc.state.tx.us or writing  
                                      to TWC Open Records, 101 E. 15 thSt., Rm. 266, Austin, TX  78778-0001. 
 
C-82 J(05    1515)