UC-201-B-S
Rev. 9-93
TRANSFER OF BUSINESS
Supplement to Employer’s Initial Statement
WORKFORCE WEST VIRGINIA
UNEMPLOYMENT COMPENSATION DIVISION
112 California Avenue
Charleston, West Virginia 25305
STATEMENT BY SUCCESSOR EMPLOYER
1. Name of Predecessor
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Account No.
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Trade Name, If Any
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Address of Operation
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Present Address of Predecessor
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2. On What Date Did You Acquire the Business?
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3. Did You Acquire All of the Predecessor’s Business in West Virginia, or Only Part?
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All
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Part
If You Acquired Only Part, (a) What Part of the Business Did You Acquire?
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(b) What Percentage of the Business Did You Acquire?
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4. Have You Continued the Business of Your Predecessor Without Interruption? FORMTEXT
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Yes
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No If “No” --- FORMTEXT
Did You Resume the Business of Your Predecessor After Interruption?
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Yes
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No
Do You Plan To Resume the Business of Your Predecessor?
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Yes
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No
If “Yes, ” When Do You Expect To Resume the Business?
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5. Did You Continue or Resume, or Do You Plan To Resume, the Same Business As That of Your
Predecessor?
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Yes
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No
If “No,” Explain:
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6. If You Continued or Resumed the Business, Do You Employ Substantially the Same Employees as
Those Your Predecessor Employed in Connection with the Assets Transferred?
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Yes
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No
7. CERTIFICATION:
Name of Successor:
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Date:
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Signature:
Title:
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STATEMENT OF PREDECESSOR
8. I Hereby Certify That All Information on Succession Furnished by the Successor Is True and That It
Is In Accordance With the Terms of Transfer.
Name of Predecessor:
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Date:
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Signature:
Title:
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Document checksum: 2436680721
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