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Form Nys-100 - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting - Department Of Taxation And Finance Page 2

Part D - Address/Telephone Information

Please enter your mailing and/or physical location address as well as the physical location of your books/records. If you wish to provide us

with additional addresses to direct specific forms, please indicate below.

(NOT

1. Mailing Address: This is YOUR business mailing address

Street or PO Box

your agent or paid preparer)

where all your Unemployment Insurance/

Withholding Tax mail will be directed unless otherwise indicated.

City

State

ZIP Code

(including

*If all your Unemployment Insurance/Withholding Tax mail

Forms NYS-45 and NYS-1)

is to be received at this mailing address,

do not complete sections 4 through 6.

Street

2. Physical Address: This is the ACTUAL location of your business

if different from the mailing address, or if your mailing address is a

P.O. Box. If you have more than one location, list your primary

City

State

ZIP Code

location.

c/o

3. Books/Records Address: This is the physical location where

your BOOKS/RECORDS can be found.

Street

Same as no. 1

Same as no. 2

Other - please complete

City

State

ZIP Code

ADDITIONAL ADDRESSES

c/o

(c/o):

4. Agent Address

This is the address of your AGENT, where

Street or PO Box

c/o

City

State

ZIP Code

Street or PO BoxCity

State

n, li8/ Other - icated75ONAL Qu001erly Comb209d -32 TD (*I

Telephone

Form Nys-100 - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting - Department Of Taxation And Finance Page 2

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