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KANSAS DEPARTMENT OF LABOR                                                                                                                           Page 1 of 3
www.dol.ks.gov
EMPLOYER ACCOUNT RECORD CHANGE                                                                              MAIL:             Kansas Department of Labor
K-CNS 0103 (Rev. 6-22)
                                                                                                                              PO Box 400
                                                                                                                              Topeka, KS 66601-0400
                                                                                                            FAX:              (785) 291-3425
(SEE INSTRUCTIONS ON PAGE 3)

1. Employer Serial Number:

2. Date of change (mm/dd/yyyy):

3. Federal Employer Identification Number (FEIN):                                                                      Is this a change?            YES                      NO

4. Legal business name:                                                                                   Is this a name change only?            YES    NO

5. Business trade name:

6. Mailing address:
                                                                                                        Is this a change in address only?         YES                        NO    
   Street or PO Box:
   City:                                                                                       State:                         ZIP:  
   Phone:

7. Kansas business physical address:       Storefront/Physical Location      Job/Construction Site         Employee Residence

   Street address:
   City:                                                                                      State:                          ZIP: 

   Phone:

8. Reason for change (use a separate form K-CNS 0103 for each successor):
   A.    Business in Kansas continues in operation without employment

   B.    Business in Kansas suspends or entirely discontinued without successor

   C.    Business in Kansas acquired by successor
              Date acquired (mm/dd/yyyy):                                                   Entirely (100%)            Partial (less than 100%)            ________% acquired

              Substantially all of the assets:           YES              NO
                                                                                                                                  (If #8 is completed for 
              Substantially all of the employing enterprise, organization, trade or business:           YES  NO               successorship, complete 
                                                                                                                                    items #9 and #10)
9. Successor information:
   Trade name:

   Owner/principal:

   Street or PO Box:                                                               Phone: (          ) 

   City:                                                                    State:                                            ZIP:

   Employer Serial Number (if available):                                   Federal            Employer Identification Number (FEIN): 

   Please transfer the previous owner’s experience rating factors as provided in K.S.A. 44-710a(b)(2):             YES        NO
   Transfer of rating factors is:   Mandatory     Elective

                                                  UNEMPLOYMENT TAX CONTRIBUTIONS
                                  PO Box 400, Topeka, KS 66601-0400 • Phone (785) 296-5027 • Fax (785) 291-3425

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Kansas Department of Labor                                                                                                             Page 2 of 3
Employer Account Record Change
K-CNS 0103 (Rev. 6-22)
10. Organizational changes with same principals as before, entity changed to:
             Individual                          Limited Partnership                Estate
             General Partnership                 Joint Venture                      Receivership
             Limited Liability Company (LLC)     Corporation (Inc.)                 Trust
             Limited Liability Partnership (LLP) Government / Political Sub-Division
             Other (describe): 
11. Change only in principals:            YES    NO        (Individual changes within the organization which DO NOT change the entity.)

Check one:            Withdrawal                 Addition Substitution               Death of Principal

             ADD            DELETE        

    SSN: ______________________________ 

    First: ______________________________________________________ MI: ______  Last: ________________________________________________

    Title: _____________________________________________________________________________________________________________________

    Residence street address: ____________________________________________________________________________________________________

    City: ______________________________________________________________ State: ______________________ ZIP: ________________________

             ADD            DELETE        

    SSN: ______________________________ 

    First: ______________________________________________________ MI:        ______  Last: ________________________________________________

    Title: _____________________________________________________________________________________________________________________

    Residence street address: ____________________________________________________________________________________________________

    City: ______________________________________________________________ State: ______________________ ZIP: ________________________

             ADD            DELETE        

    SSN: ______________________________ 

    First: ______________________________________________________ MI: ______  Last: ________________________________________________

    Title: _____________________________________________________________________________________________________________________

    Residence street address: ____________________________________________________________________________________________________

    City: ______________________________________________________________ State: ______________________ ZIP: ________________________

NOTE: K.S.A. 44-710 a (b)(2) provides that a successor employer as defined in subsection (h)(4) or (dd) of K.S.A. 44-703 may receive 
the experience rating factors of the predecessor employer if an application is made in writing within 120 days of the date of the business 
transfer. The experience rating factors consist of all contributions paid, annual payrolls and benefit experience of the predecessor 
employer. These factors will be used in computing your future rate if you elect to have them transferred.
12. CERTIFICATION:  I certify that the information provided on this report to be true and correct to the best of my knowledge and belief.

Signature of Employer/Representative                            Title                                          Date Prepared    

Email                                                           Phone
                                                          UNEMPLOYMENT TAX CONTRIBUTIONS
                                 PO Box 400, Topeka, KS 66601-0400 • Phone (785) 296-5027 • Fax (785) 291-3425

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Kansas Department of Labor Page 3 of 3
Employer Account Record Change
K-CNS 0103 (Rev. 6-22)

The Employment Security Law, K.S.A. 44-703 et seq., provides that the experience rating account of the predecessor may be acquired by
the successor whenever an employing unit acquires or in any manner succeeds, including, but not limited to, buying substantially all of the:

Employing Enterprise .......Those business locations with employment
Organization .....................Employees or employee position(s) required to continue the business.
Trade or Business ............Clientele or customers that frequent the business; the goods or services provided; or some combination.
Assets of an Employer......The assets considered are those items that are necessary to the normal operation of the business: real property,
.............................equipment, inventories, etc. If only a portion of the business was acquired, a description of the portions acquired
.............................and retained is required. Attach additional pages for this explanation.

Completing the Employer Account Record Change
1. Enter your unemployment insurance tax serial number as it be transferred to your successor. Indicate whether the
appears on the K-CNS 100. The serial number is a six-digit acquisition was total or partial. Also, report the date your
number printed at the top of the report. business was acquired.
2. Enter the date the change in your employer status occurred. 9. Enter the successor’s information; to include name, address,
3. Enter your Federal Employer Identification number (FEIN) phone number,FEIN and Transfer of Rating Factors.
issued to your business by the Internal Revenue Service. 10. Indicate if the form of the organization has changed. If the form
Please indicate if the FEIN has changed. did change, and the same individuals remain in control of the
4. Enter your Legal Business Name as it is registered with the new organization, this change is characterized as a Mandatory
State of Kansas. Successorship by Kansas statute. For example:
A sole proprietor incorporates and continues to operate
5. Enter your Business Trade Name (if applicable). the same enterprise. The experience rating factor transfer would
6. Enter the mailing address where you would like to receive be mandatory. The corporation would continue to pay
agency correspondence. unemployment taxes at the same rate as the sole proprietor. By
7. Enter the physical location in Kansas. This can be an statute, corporate officers are employees of the corporation. The
employee’s residence, job site or actual business location. compensation paid to officers for service to the corporation
must be reported as wages.
8. Indicate the type of change in your employer status. Mark only
one: A, B or C 11. Indicate if there was a change or substitution of Principals. Enter
the name(s) of the partner(s) that changed. Indicate if the
A. If your operation is continuing with no employees, or partnership continues to use the same federal employer’s tax ID
no money being paid for performing services, we will number (FEIN). Enter the FEIN. Generally, if one of the original
make your account inactive. Inactive accounts are not partners remains, we will note the new partners but make no
required to file a K-CNS 100, Quarterly Wage Report change in the account. If the IRS has issued a new FEIN and
and Unemployment Tax Return. When you resume wages have been reported under the new number, we can
employment, you must notify us; your account will return assign you a new Kansas unemployment tax number to assist
to active. Accounts inactive for three complete calendar with federal unemployment tax payment certification. Enter the
years will be terminated. individual changes within the organization. These changes DO
B. If you suspended your operation or discontinued it without NOT change the established entity. This will include Partners,
a successor, we will make your account inactive. When Corporate Officers, etc.
you resume the business or start another, you must 12. The Employer Account Record Change must be signed by the
notify us. Your account will return to active. Accounts that owner, partner, corporate officer or designated employee. Print
are inactive for three complete calendar years will be your title and the date you sign it. Provide email and phone
terminated. number. Return the completed notice to:
C. If your operation was acquired by a successor, your Kansas Department of Labor
account will be terminated. In most cases, your PO Box 400
experience rating factors, taxes, payrolls and claims will Topeka, KS 66601-0400

For help in completing this notice, you may call your local unemployment tax office. A list of offices is online at:
www.dol.ks.gov/employers
Assistance is also available from our administrative office in Topeka:
Phone: (785) 296-5027 • Fax: (785) 291-3425
Frequently used reports are available online at:
www.dol.ks.gov/employers

UNEMPLOYMENT TAX CONTRIBUTIONS
PO Box 400, Topeka, KS 66601-0400 • Phone (785) 296-5027 • Fax (785) 291-3425

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