The South Dakota 55 form, also known as the Application for Exemption or Transfer of Liability, is used to request exemption from filing unemployment insurance reports in South Dakota. This form is essential for businesses that have ceased operations or have undergone ownership changes. Completing the form accurately ensures that the necessary information is communicated to the South Dakota Department of Labor and Regulation.
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The South Dakota 55 form is an essential document for individuals and businesses navigating changes in their employment status or business ownership. It serves as an application for exemption from filing reports required under the state's unemployment insurance law. By completing this form, applicants can indicate their intent to cease operations or transfer their business to a new owner. Key sections of the form require detailed information, including the account number, business name, and mailing address, ensuring that all correspondence is directed to the correct location. Additionally, applicants must provide the last date wages were paid and specify the nature of the business transfer, whether through sale, merger, or other means. The form also facilitates the transfer of the employer's experience rating account, which can impact future unemployment insurance rates. This process not only helps former business owners but also supports new owners in understanding their responsibilities. By signing the form, the applicant confirms their agreement to notify the South Dakota Unemployment Insurance Division should their employment status change in the future. Completing the South Dakota 55 form is a critical step in ensuring compliance with state regulations while also protecting the interests of all parties involved.
Form 55 (rev. 4/14)
APPLICATION FOR EXEMPTION OR TRANSFER OF LIABILITY
South Dakota Department of Labor and Regulation
Unemployment Insurance Division
PO Box 4730, Aberdeen, SD 57402-4730 Phone 605.626.2312 Fax 605.626.3347 www.sdjobs.org
1. Account Number ____________________
Owner or Corporate Name_________________________________________________________________________
Business Name or DBA ___________________________________________________________________________
Mailing Address _________________________________________________________________________________
Address
City
State
Zip
(Note: mailing address above will receive all information including debit/credit notices, benefit charges, claim notices and appeals.)
2.I hereby make application for exemption from filing all reports required under the unemployment insurance law of South Dakota. I agree to advise SD Unemployment Insurance Division if I have employment again at any time in the future.
If employment ceased or business was discontinued without a successor, give last date wages were paid __________
or
If business was sold, leased or otherwise transferred, please complete the following:
Effective date of disposition __________________ Date you last paid wages in South Dakota _________________
Are you retaining any part of the business? Yes ___
No ___
Disposed of the business by:
( ) Sale
( ) Merger
( ) Receivership
( ) LLP
( ) LLC
( ) Incorporation
() Dissolution ( ) Partnership ( ) Other ________________________________________________________
3.Name of successor _______________________________________________ Phone ________________________
Address of successor ____________________________________________________________________________
Type of organization: (Check one)
( ) Individual
( ) Corporation
(
) Partnership
( ) Association
( ) Other __________________________________________________________________________________
4. It is agreed between the Former Owner and the New Owner that: ( ) All
) None
) Portion of the
Employer’s Experience Rating Account shall be transferred with assets and liabilities following the account, as
provided in Section 61-5-42 SDCL.
5.This report must be signed by the owner, partner or authorized official.
Signature ______________________________ Title _______________ Phone ____________ Date _______________
For SD DLR use only:
Approved date ________________________ By _________________
Effective date ________________________
Termination date ______________________
Registration
South Dakota Unemployment Employer Registration - Must be used for each year that requires corrections, with a separate report for each.
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