Form Es-802 - Status Report
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2DO NOT WRITE IN THIS BLOCK
Code: ____________Lia. Date:______________________#________________
ES-802 Rev 07/07
NEW MEXICO DEPARTMENT OF WORKFORCE SOLUTIONS
Labels:_________Cont.Accrue:_________Rate:___________Field Code:_____
Workforce Transition Services Division/Tax Section
P.O. Box 2281, Albuquerque, New Mexico 87103
Qtr. Lia. Incurred:__________________Sec.Law_________________________
Telephone Number: (505) 841-8576
STATUS REPORT
Complete all items on front and back of form within 10 days. Failure to complete the ES-802 form in its entirety will result in returning the form and
may cause delay in processing.
If you are already registered with this agency enter account
number.___________________________________________
1. Fed IRS ID # (9digits)
1a. Taxation & Revenue ID#
-
-
1b. Telephone Number (1-800 if available)
2. Legal Name [Sole Proprietor (Last Name First) or Corporation etc.]
2a. Business Name (d/b/a)
3. Mailing Address (P.O. Box, Street #, Rural Route etc.)
City
State
Zip Code
3a. New Mexico Principle Business Location (Street Address, only)
City
Zip Code
County
Telephone Number
3b. Name, Address and Telephone Number where accounting records may by examined (indicate if different than answer in number 3a.)
________________________________________________________________________________________________________________________
4. List other New Mexico businesses and their locations this entity is currently operating. Give total number of Businesses_____________________
Name of Business
Location
Date Started
Nature of Bus.
5.Indicate with a bcheck mark type of organization.
Proprietorship
Corporation
General Partnership
Indian Tribe/Unit
Non-profit
Gov.
Limited Partnership
Limited Liability Partnership
Limited Liability Company
Other___________________________________________________
Submit a copy of Sec. of State Certificate
Submit Articles of Organization and IRS Election
(for Ltd Partnerships only)
(for Ltd Liability Companies only)
5b.Name of state of incorporation________________________________________Date_____________NMSC NO.__________________________
5c.Provide a detailed description of the principle activity in New Mexico. (types of products or services provided and primary customer ( i.e.
construction of single-family dwelling or retail sale of children’s clothing)____________________________________________________________
________________________________________________________________________________________________________________________
5d.List owner’s name, address, and social security number
(If a partnership—list partners. If a corporation—list officers)
Last Name, First, MI
Social Security
Title
% of
Address
Number
Ownership
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