Michigan Unemployment Insurance Agency                                                                                                  RESET FORM
518 Schedule B (Rev. 11-07)

UIA Schedule B - Successorship Questionnaire
Issued under authority of the Michigan Employment Security Act of 1936, as amended, MCL 421.1 et seq. Filing is mandatory for employers.
You must complete all items on this form accurately and completely. Failure to do so may subject you to the penalties
provided under the Michigan Employment Security (MES) Act.  Attach additional sheets if necessary. 
Successorship Reporting Requirement. If you acquired any part of the Michigan assets, trade or business of another 
employer, as defined in Part 3 of this form, by purchase, rental, lease, inheritance, merger, foreclosure, bankruptcy, gift or any
other form of transfer, you must provide the following information. If you made multiple acquisitions, you must file a separate
UIA Schedule B for each acquisition (photocopies of this form are acceptable). If you made no acquisitions, you are still 
required to complete this schedule. If subsequent to completing this registration form, you transfer the assets (by sale or 
transfer), organization (payroll/employees), trade (customers/accounts), or business (products/services), in whole or in part, to a
new or previously existing business in Michigan, it is mandatory that you notify this Agency immediately by completing an 
additional Schedule B. 
UIA Account Number                                             Federal Employer Identification No. 
(if already assigned)                                          (required)
PART I:   QUESTIONS ABOUT PRIOR OR CURRENT BUSINESS FORMATIONS, ACQUISITIONS OR MERGERS
For each of the following five business formation, acquisition or merger types, the employer must indicate the pertinent business
name, address and UIA Account Number in the space provided.
1.  In the past 6 years, you formed, acquired or merged with a business by any means.  If not applicable, check box
                                       Business Name and Address                                                                        UIA Account Number

a.  If you formed a new business, what did you acquire from the previously existing business?  (check all that apply)
      Land   Buildings                  Furniture/Fixtures       Equipment   Inventory               Accounts Receivable                  Goodwill
      Employees                 Trade    Customer Accounts       None
b.  If you purchased, acquired or merged with an existing business by any means (including lease), what assets did you acquire? 
    (check all that apply)
      Land   Buildings                  Furniture/Fixtures       Equipment   Inventory               Accounts Receivable                  Goodwill
      Employees                 Trade    Customer Accounts       None
c.  What was the business activity of the previous business?

2.  At the current time, you are forming, or acquiring, a business by any means.  If not applicable, check box
                                       Business Name and Address                                                                        UIA Account Number

a.  If you formed a new business, what did you acquire from a previously existing business?  (check all that apply)
      Land   Buildings                  Furniture/Fixtures       Equipment   Inventory               Accounts Receivable                  Goodwill
      Employees                 Trade    Customer Accounts       None
b.  If you are purchasing or acquiring an existing business by any means (including by lease), what assets are you acquiring? 
    (check all that apply)
      Land   Buildings                  Furniture/Fixtures       Equipment   Inventory               Accounts Receivable                  Goodwill
      Employees                 Trade    Customer Accounts       None
c.  Will any owner or owners of the previous business continue to operate or manage the business being registered by this form?
    Yes    No If yes, provide name, title and business address below.

d.  What was the business activity of the previous business?

e.  What will be the business activity, if any, of the previous business after the new business being registered is formed?

f.  What will be the business activity of the new business being registered by this form?

518 Schedule B, Page 2

PART I:   QUESTIONS ABOUT PRIOR OR CURRENT BUSINESS FORMATIONS, ACQUISITIONS OR MERGERS (continued)

3.  At the current time, you are incorporating an existing business entity. If not applicable, check box
                                  Business Name and Address                                             UIA Account Number

a.  What was the business activity of the business entity you are incorporating?

b.  What will be the business activity of the new business being registered by this form?

4.  At the current time, you are merging, by any means, with one or more business entities. If not applicable, check box
                                  Business Name and Address                                             UIA Account Number

a.  If you are purchasing or acquiring an existing business by merger, what are you acquiring? (check all that apply)
      Land              Buildings   Furniture/Fixtures   Equipment   Inventory    Accounts Receivable                  Goodwill
      Employees            Trade    Customer Accounts    None
b.   If you are forming a new business, what are you acquiring from a previously existing business? (check all that apply)
      Land              Buildings   Furniture/Fixtures   Equipment   Inventory    Accounts Receivable                  Goodwill
      Employees            Trade    Customer Accounts    None
c.  Will any owner or owners of the merging business continue to operate or manage the business being registered by this form?
    Yes               No If yes, provide name, title and business address below.

d.  What was the business activity of the merging business?

e.  What will be the business activity of the continuing business being registered by this form?

5.  You are intending to form a business at a future time, by any means. If not applicable, check box
    Yes               No

If yes, please explain:

518 Schedule B, Page 3

PART II:   FORMER OWNER INFORMATION
Former Owner's Name                                                         Former Owner's UIA Account Number or FEIN, if known.

Corporate Name or DBA                                                       Area Code & Telephone Number

Current  Street Address (not a P.O. Box)

City, State, ZIP

PART III:   ACQUISITION INFORMATION

                                                                                 What Percent? Date Acquired
1.    Did you acquire all, part, or none of the assets of any 
      former business?                                                  All Part       %                                        None

2.    Did you acquire all, part, or none of the organization 
      (employees/payroll/personnel) of any former business?
                                                                                 What Percent? Date Acquired
      a.  If all or part, indicate the percent and date acquired.       All Part       %                                        None
      b.  Did you acquire all or part of the 
          employees/payroll/personnel of any former business 
          by leasing any of those employee/payroll/personnel?           Yes No (If yes, provide a copy of your lease agreement)
3.    Did you acquire all, part, or none of the trade                            What Percent? Date Acquired
      (customers/accounts/clients) of any former business?              All Part       %                                        None
4.    Did you acquire all, part, or none of the former owner's                   What Percent? Date Acquired
      Michigan business (products/services) of any former               All Part       %                                        None
      business?
                                                                                 Month         Day                       Year
5.    Was the Michigan business described in 1-4 above being 
      operated at the time of acquisition? If no, enter the date        Yes No
      it ceased operation.

6.    Are you conducting/operating the Michigan business you 
                                                                        Yes No
      acquired?
7.    Is your Michigan business substantially owned or 
      controlled in any way by the same interests that owned 
      or controlled the organization, business or assets of a           Yes No
      former business?

8.    Did you hold any secured interest in any of the                                                                   
      Michigan assets acquired?                                         Yes No   If yes, enter balance owed             $

9.    Enter the reasonable value of the Michigan organization,         
      trade, business or assets acquired?                              $

Providing inaccurate or incomplete information in this Registration, or UIA Schedules A or B, will be evidence of
intentional misrepresentation and may subject you to the civil and/or criminal penalties in Sections 54 and 54b of the
Michigan Employment Securities (MES) Act.
Print Name of Owner/Officer                                                 Signature of Owner/Officer/Authorized Agent

Title                                   Telephone Number          Date

Print Name of Owner/Officer                                                 Signature of Owner/Officer/Authorized Agent

Title                                   Telephone Number          Date

Attach this schedule to Form 518, Registration for Michigan Taxes and mail it to the Michigan Department of Treasury.