Form Es-802o - Election Of Employer'S Option To Become Liable For Payments In Lieu Of Contributions

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STATE OF NEW MEXICO
DEPARTMENT OF WORKFORCE SOLUTIONS
401 Broadway, NE
PO Box 2281
Albuquerque, NM 87103
ELECTION OF EMPLOYER’S OPTION TO BECOME LIABLE FOR
PAYMENTS IN LIEU OF CONTRIBUTIONS
TO:
New Mexico Department of Workforce Solutions
PO Box 2281
Albuquerque, NM 87103
Pursuant to the provisions of Section 51-1-13 NMSA 1978 and Regulation 11.3.400.421, the undersigned,
an employing unit subject to the said Act, does hereby elect to make payments in lieu of contributions
beginning on ______________________________, and for a period of not less than two consecutive
calendar years.
Employing Unit is applying under NMSA 1978 Section 51-1-13. Government entities are not
required to send the attachments below:
Completed Form ES-802, Status Report
Copy of the IRS Exemption under Section 501(c)(3) of the IRS Code.
Surety Bond or Cash Security Deposit
Employing Unit is applying under NMSA 1978 Section 51-1-59 Indian Tribes, the employing
unit is to attach the following:
Completed Form ES-802, Status Report
The undersigned requests written approval by the New Mexico Department of Workforce Solutions of this
election.
Enter the Taxable Wages paid during the prior four (4) calendar quarters ending June 30. If no wages were
paid during the preceding four (4) calendar quarters ending June 30, please estimate the amount to be paid.
st
rd
1
Quarter 20_______$____________________
3
Quarter 20_______$___________________
nd
th
2
Quarter 20_______$___________________
4
Quarter 20_______$___________________
_____________________________________________
__________________________
LEGAL NAME OF EMPLOYER
DATE
______________________________________
________________________________
Prepared by
Title
DECLARATION OF VERIFYING OFFICER: The above person whose signature appears on this document is a duly
authorized representative of the employing unit, empowered to exercise this option.
The above election commencing as of _________________________, 20________ is
Approved
Disapproved
Account No. ________________________
By:_______________________________________________
Date:___________________
Title:______________________________________________
ES-802O, Rev 7.07

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