Fillable Printable Change of Employer Account Information - California
Fillable Printable Change of Employer Account Information - California
Change of Employer Account Information - California
DE 24 Rev. 6 (9-12) (INTERNET) Page 1 of 2 CU
CHANGE OF EMPLOYER ACCOUNT INFO RMATION
EDD ACCOUNT NUMBER:
Corporation/
Owner’s Name:
Business
Name (DBA):
Banking I nstitution:
PLEASE INDICATE CHANGES/CORRECTIONS THAT APPLY TO YOUR BUSINESS (A-1 BELOW):
A. Address Change/Correction: Date of Chang e: / / (En ter address info rmation in b o x 1)
1.
NUMBER AND STREET
CIT Y, ST ATE, AND ZIP CODE
PHONE NUMBER
(
)
B. Business Name (DBA) Change: Date of Change: / /
C. Corporation Name Change: Date of Change: / /
D. Personal Name Change (i.e., marriage): Date of Change: / /
E. Change of Ownership - Date of Change: / / (Mark appropriate box below, an d complete box 2 if
required):
Partial Sale, Not Out-Of-Business Entire Business Sold (E n ter succe sso r[s] informa tion in box 2)
Corporation Dissolved Other (Explain):
Corporation Formed Change in Ownership Type (Add information in box 2 and explain Type)
Purchase Price $
2.
OWNER’ S NAME( S ) FOLL O WING
CHANGE OF OWNERSHIP
TITLE
BUSINESS NAME (DBA)/
CORPO RAT ION NAME
MAILING
ADDRESS
New FEIN (Tax ID#): OLD FEIN (Tax ID#):
Explain reason for new Tax ID:
SOS Corporation,
LLC, LLP, or LP
Identification #:
F. Change in Partner(s), Officer(s), Member(s), Manager(s), etc. (Mark a p p ropriate box to Add [A], Change [C], or
Delete [D], and enter the new inform ation as required.) Attach additional sheet(s) if ne eded.
3.
A
C
D
DATE O F
CHANGE
INDIVIDUAL (S) TO BE ADDED/
CHANGED/DELETED
TITLE
SOCIAL SECURITY
NUMBER
DRIVER’S
LICENSE NUMBER
/ /
/ /
/ /
G. No wages paid during entire quarter(s). Please enter the appropriate year and quarter in the boxes provided.
(Example: YYYY/Q)
H. Discontinued Paying Wages. Date last wage payment was made: / / . All required EDD TAX FORMS
have been file d . (Attach Copies)
I. If you currently use a Professional Employer Organization (PEO), please provide PEO info rmation:
PEO Name:
PEO Address:
PEO EDD Account Number: PEO Start Date:
Mail to:
Employment Development Department
Account Services Group, MIC 28
P.O. Box 826880
Sacramento, CA 94280-0001
DE 24 Rev. 6 (9-12) (INTERNET) Page 2 of 2 CU
J. Out of Business (Without a Successor) on: / / . (Provid e forwarding address in box A-1)
Note: If busi n ess corporation/owner is represented by an authorize d agent for employment tax purposes, the
agent may sign below. A signed and properly executed power of a tto rney must be attache d or on file. THE
SIGNATURE OF ANY OTHER PERSON/THIRD PARTY WILL NOT BE ACCEPTED.
“I certify under penalty of perjury that the above information is true and correct, and that these actions are not being
taken to receive a more favorable Unemployment Insurance rate. I further certify that I have the authority to sign on
behalf of the above business.”
( ) / /
Signature Phone Number Date
Print Name Title (Officer, Owner, Member, GP, or Authorized Agent)
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