IF YOU ACQUIRED A BUSINESS  
                            
                       WYOMING WORKERS’ COMPENSATION  
                           and UNEMPLOYMENT INSURANCE 
                                                
                           TRANSFER OF EXPERIENCE RATE  
                                                
When a person acquires the trade, organization, business, substantially all of the assets or 
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some or all the workforce of an employer, that person shall assume the account(s), benefit 
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experience (UI) / claims experience (WC) and tax rate(s) of the relinquishing party.               
 
NOTE: A person who knowingly or with deliberate disregard of the facts or the requirements 
of the Wyoming Employment Security Law or the Wyoming Workers’  Compensation Act, 
violates  or  attempts  to  violate  or  who  knowingly  advises  another  to  violate  these  Acts 
related  to  determining  the  assignment  of  a  contribution  rate  shall  be  subject  to  civil  and 
felony penalties punishable by a fine of not more than $50,000, imprisonment for not more 
than 5 years, or both. 
  
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Certification  
 
The undersigned jointly confirm and certify to the Department that 
_________________________________(“Acquiring          Party”)        acquired the                   trade, 
organization,  business,  substantially  all  of  the  assets  or  some  or  all  of  the  workforce  of 
_________________________________(“Relinquishing  Party”)  and  understand  that  the 
Acquiring Party shall assume the account(s), benefits experience (UI) / claims experience 
(WC) and tax rate(s) of the Relinquishing Party based upon said acquisition.  
 
Acquisition Effective Date: ______________________________________________  
 
Acquiring Party’s Authorized Signature                                  Date  
 
Relinquishing Party’s Authorized Signature                              Date  
 
1 The transfer of some or all of an employer’s workforce shall be considered a transfer of trade or 
business when, as a result of the transfer, the transferring employer no longer performs trade or business 
with respect to the transferred workforce, and the trade or business is performed by the person or 
entity to whom the workforce is transferred.  
2 If the relinquishing party remains in business or begins a new business, the relinquishing party shall be 
treated as a new employer and assigned an account(s) and tax rate(s) as such. As a new employer, the 
relinquishing party must submit a new, completed registration form.  
3The Department may determine a predecessor/successor relationship without Acquiring Party or 
Relinquishing Party signatures, based on available information and application of the statutes.  
 
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