Ohio Department of Job and Family Services 
                                   Office of Unemployment Insurance Operations 
                         APPLICATION FOR VOLUNTARY SUCCESSORSHIP 
                             TRANSFER OF SUBSTANTIALLY ALL ASSETS 
 
 Successor Employer Name 
 
Successor Employer ID  Note: If you do not have an Employer ID, you must submit a Report Successor Phone Number: 
to Determine Liability (JFS 20100) with this application. 
 
If you have not already submitted a Transfer of Business form (JFS 20101), you must submit one with this 
application. 
 
Predecessor Employer Name 
 
Predecessor Employer ID                                                                  Predecessor Phone Number: 
 
If you have not already submitted an Inactivation Request form (JFS 20110), you must submit one with this 
application. 
 
What was the date of the transfer? 
 
Enter the number of individuals employed by the predecessor at the     Enter the number of individuals employed by the successor 
time of transfer.                                                      immediately after the acquisition. 
 
Provide the monetary value of the total assets of the predecessor at   Provide the monetary value of the assets the successor acquired at 
the time of acquisition (including, but not limited to, a valuation of the time of acquisition(including, but not limited to, a valuation of 
real property and personal property consistent with the most recent    real property and personal property consistent with the most recent 
valuation for federal tax purposes and intangible property, including  valuation for federal tax purposes and intangible property, 
the value of accounts receivable, patents, trademarks and goodwill).   including the value of accounts receivable, patents, trademarks and 
                                                                       goodwill). 
                                                                        
 $                                                                      $ 
 
JFS 20118 (Rev. 7/2020)                                                 unemployment.ohio.gov                                                                          Page 1 of 2 

Please read carefully. 
 
We hereby certify that the information provided in this application is true to the best of our knowledge and belief. 
We request that the transferee be made a successor in interest to the transferor's account and, as such, assume all 
the resources and liabilities of the transferor's account. Furthermore, we acknowledge that all unemployment 
insurance tax, interest and penalty(s) due to the agency on the date of the transfer (by both the 
transferor(predecessor) and transferee(successor)) must be paid in full in order for the application to be approved. 
 
Successor Signature      Date 
                          
Title 
 
Predecessor Signature    Date 
                          
Title 
 
      P.O. Box 182404     Columbus, OH 43218-2404     (614) 466-2319     unemployment.ohio.gov 
                        
JFS 20118 (Rev. 7/2020)                                                 unemployment.ohio.gov                                                                          Page 2 of 2