TX-13 (Revision Date (05/06/2022)
                                                          STATE OF RHODE ISLAND
                     DEPARTMENT OF LABOR AND TRAINING - EMPLOYER TAX UNIT
                                                                          
                                        1511 PONTIAC AVENUE,  CRANSTON, RI     02920 - 0942
                            Telephone - 1- 401-574-8700 Option (1)        Fax :   1-401-574-8940 TTY Relay via 711

                                        https://dlt.ri.gov/employers/employer-tax-unit
                            EMPLOYER TERMINATION OF REGISTRATION REPORT

                                                                          RI Reg No

                                                                              Person having custody of Books and Records
   EMPLOYER 
1. NAME                                                                   2   NAME
   BUSINESS 
   ADDRESS                                                                    ADDRESS
   CITY,                                                                      CITY, STATE, 
   STATE                                         zip code                     ZIP CODE

3. (a)    Reason for Termination of Registration:

   Sale                                          Lease                                           Foreclosure
   Liquidation                                   Death of Owner                                  Receivership
   Reorganization                                Bankruptcy                                      Merger
   Other  (Explain)

   (b)  What percentage of the business was transferred? (If Applicable )

   (c)  Date of Action in 3(a) above

   (d)  Date of Last Payroll

   (e)  Give the following information concerning Owners, Partners, Corporate Officers, etc.:
                                                 HOME ADDRESS 
   NAME                                                   & ZIP CODE                             TITLE            TEL. NO.

4. (a)    Name of new business (If any):
   (b) Name, address and ZIP code of New Owners, (If any):

                                                                              Tel. No.

5. (a)   Are you continuing any other business in Rhode Island ?          YES         NO
   If Yes,
   (b)  Name, address and zip code of Continuing Business:

                     DATE                                   SIGNATURE                                        TITLE

                                                 THIS FORM MUST BE SIGNED

                     An equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities.