Unemployment Insurance Tax Bureau 
                                                                                                                  1000 E Grand Avenue 
                                                                                                                  Des Moines, Iowa 50319 

                Use this form to report changes in account information.  Attach any documentation you feel is necessary.

UI Account #:                                  Legal Business Name:
                                        If your Legal Entity Type or Federal Identification Number (FEIN) has changed for any reason,  
Business Information Change             complete the "Change in Ownership" section below or attach a letter.
Legal Business                                                                      Legal Entity Type 
Name Changed to:                                                                    Changed to:

DBA Changed to:
                                        Select the address(es) you are changing and provide the new information.  
Address Information Change              If you added locations, attach a list providing the full name, address and phone number of each location.
Primary Address         Mailing Address Reporting Unit #:                           Primary Address           Mailing Address Reporting Unit #:
Address 1:                                                                          Address 1:
Address 2:                                                                          Address 2:
City:                                   State:                                      City:                                     State:
Zip+4/Postal:                            Phone:                                     Zip+4/Postal:                              Phone:

Inactivate Account Request
Reason:         Business closed (If sold or transferred, complete the "Change of Owner" section below.)
                        Date business closed:                                       Date last wages were paid:
                Operating without employees in Iowa (Corporate officer salaries ARE wages and ARE taxable.)   Date last wages were paid:
  Bankruptcy Information - If your business has filed for bankruptcy, complete the information below.
Bankruptcy Court:                                                                   Attorney Name:
Chapter Number:                                 Type of Bankruptcy:                 Address:
Case Number:                                        Personal                        City:                                                        State:
Petition (File) Date:                               Business                        Zip+4/Postal:                             Phone:

Ownership Change - Includes Sale, Assumption, Merger, Transfer, Lease
Provide future address information in the Address Information Change section above. 
Reason:         Sold, merged, leased or transferred PART of Iowa business                 Sold, assumed, merged, leased or transferred ALL of Iowa business
Portion of Iowa business sold, merged, leased or transferred:                       Legal date of transfer:
                                                                                    Date last wages were paid:
                                                                                    Does the business continue to generate Iowa payroll?         Yes   No

  New Ownership Information - Provide the following information about the new owner, if known.
Owner Name:                                                                                             Contact Person:
Address 1:                                                                                              Contact Phone:
Address 2:
City:                           State:              Zip+4/Postal:
I certify that the information in this notice is complete and correct. If my account is inactive, I will notify Iowa Workforce Development immediately if employment in 
Iowa is resumed.
Signature:                                                       Title: 
Print Name:                                                      Phone:                                           Date:
Note: Information collected from employers by the Unemployment Insurance Services Division of Iowa Workforce Development may also be 
provided to various federal and state agencies as required or permitted by federal and state law. 
                                               Employer's Notice of Change 60-0111 (01-2024)                  Print Form
                                        Phone:  (888) 848-7442     Email:  iwduitax@iwd.iowa.gov 
                                                              www.workforce.iowa.gov  
                                                    Equal Opportunity Employer/Program 
                                Auxiliary aids and services are available upon request to individuals with disabilities. 
                                                For deaf and hard of hearing, use Relay 711.