Joint Business Registration Form - Wyoming Department Of Workforce Services Page 4
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5Domestic Employers, Agricultural Employers, Non-Profit organizations, LLCs, and Political
Subdivisions answer Questions 14, 15, 16, or 17.
All other employers skip to the “Signature is Required” area
14. For Employers of Domestic (household) help only:
Have you or will you have a total payroll of $1,000 or more during any calendar quarter?
Yes
No
If yes, what calendar quarter and year?
15. For Agricultural operations only:
15a. Have you paid or will you pay $20,000 or more in wages during any calendar quarter?
Yes
No
If yes, what calendar quarter and year?
15b. Have you had or will you have 10 or more workers for 20 weeks or more in any calendar year?
Yes
No
If yes, what calendar quarter and year?
16. For 501(c)(3) Non-Profit Organizations only
:
You must provide a copy of your 501(c)(3) exemption letter from the IRS)
(
Did your entire organization employ four (4) or more persons in twenty (20) weeks during any calendar year including full and
part time employees?
Yes
No If yes, what date? _____________________
For Unemployment Insurance, do you wish to elect: (check only one)
Liability on a tax basis
Reimbursement of benefits paid to former employees
No If no, do you wish to have optional Unemployment Insurance Coverage? Yes
No
17. For LLCs only:
Do you wish to elect Unemployment Insurance coverage for LLC members? Yes
No
Per W.S. 27-3-502(d) An employing unit not qualifying as an employer or for which services not qualifying as employment
are performed may elect coverage under this act for a period of not less than two (2) years by filing written notice of its
election with the department……
***** Please note: If you elected to be taxed federally as a Corporation, and do not elect to cover your LLC members under
SUTA, you will not be eligible for the SUTA credit and will pay FUTA at the full federal rate.
18. For Political Subdivisions only:
City
State
Board of Education
Town
School District
Other
County
College or University
For Unemployment Insurance, do you wish to elect: (check only one)
Liability on a tax basis
Reimbursement of benefits paid to former employees
Signature is Required
If You Are:
Who Must Sign:
A Corporation
An Officer authorized to sign on behalf of the corporation
A Partnership
One Partner
A Limited Liability Company
The Managing Member
A Sole Ownership
The Owner
I certify this application has been examined by me and to the best of my
knowledge and belief is true, correct, and complete.
Signature:
Name:
Title:
Date:
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