Form C-1bk - Status Report - 1999
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1
2MAIL TO:
CASHIER
TEXAS WORKFORCE COMMISSION
PO BOX 149080
AUSTIN, TEXAS 78714-9080
STATUS REPORT
THIS REPORT IS REQUIRED OF EVERY EMPLOYING UNIT,
AND WILL BE USED TO DETERMINE LIABILITY UNDER THE TEXAS UNEMPLOYMENT COMPENSATION ACT.
(YOU SHOULD RETAIN A COPY FOR YOUR FILES)
IDENTIFICATION SECTION
1. ACCOUNT NUMBER ASSIGNED BY TWC (IF ANY)
2. FEDERAL EMPLOYER ID NUMBER
3.
TYPE OF OWNERSHIP (CHECK ONE)
1.
CORPORATION
PROFESSIONAL ASSOCIATION
STATE AGENCY
4. NAME
2.
PARTNERSHIP
LIMITED PARTNERSHIP
POLITICAL SUBDIVISION
3.
INDIVIDUAL (SOLE PROPRIETOR)
4.
ESTATE
------------------------------------
5.
TRUST
5. MAILING ADDRESS
6.
OTHER (SPECIFY)
6. CITY
7. COUNTY
8. STATE
8(a). ZIP CODE
9. PHONE NUMBER
(
)
10.
ADDRESS
PHONE NUMBER
BUSINESS ADDRESS WHERE RECORDS OR
(
)
PAYROLLS ARE KEPT:
CITY
STATE
ZIP
(IF DIFFERENT FROM ABOVE)
11.
NAME
SOCIAL SECURITY NUMBER
TITLE
RESIDENCE ADDRESS, CITY, STATE, ZIP
OWNERS
-
-
OR
OFFICERS
-
-
[ATTACH
ADDITIONAL
SHEET IF
-
-
NECESSARY]
12.
TRADENAME
STREET ADDRESS, CITY, COUNTY
KIND OF BUSINESS
NUMBER OF
BUSINESS
EMPLOYEES
LOCATION
IN TEXAS
[ATTACH
ADDITIONAL
SHEET IF
NECESSARY]
13
CHARTER NUMBER
STATE INCORPORATED
DATE INCORPORATED
REGISTERED AGENT'S NAME
IF YOUR
BUSINESS
IS A
ORIGINAL CORPORATE NAME, IF DIFFERENT THAN ABOVE
REGISTERED AGENT'S ADDRESS
CORPORATION,
ENTER:
EMPLOYMENT SECTION
14.
MONTH
DAY
YEAR
ENTER THE DATE ON WHICH YOUR ORGANIZATION FIRST EMPLOYED SOMEONE IN TEXAS:
15.
ENTER THE DATE ON WHICH YOUR ORGANIZATION FIRST PAID WAGES TO SOMEONE IN TEXAS:
16.
ENTER THE DATE YOUR ORGANIZATION RESUMED EMPLOYING SOMEONE IN TEXAS:
IF YOUR ACCOUNT
HAS BEEN
INACTIVE:
ENTER THE DATE YOUR ORGANIZATION RESUMED PAYING WAGES IN TEXAS:
17.
ENTER THE ENDING DATE OF THE TWENTIETH WEEK OF EMPLOYMENT IN THE CALENDAR YEAR IN WHICH THIS
ORGANIZATION HAD AT LEAST ONE PERSON EMPLOYED IN TEXAS:
18.
IF YOUR ORGANIZATION HAS PAID WAGES OF $1,500 OR MORE IN A CALENDAR QUARTER, ENTER THE ENDING
DATE OF THE FIRST QUARTER IN WHICH THIS OCCURRED:
19.
IF YOU HOLD AN EXEMPTION FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION
501(C)(3), ATTACH A COPY OF YOUR EXEMPTION LETTER. ALSO, ENTER THE ENDING DATE OF THE TWENTIETH
WEEK OF THE CALENDAR YEAR IN WHICH 4 OR MORE PERSONS WERE EMPLOYED IN TEXAS:
20.
PREVIOUS OWNER'S TWC ACCOUNT NUMBER (IF KNOWN)
! !
!
IF THE BUSINESS
DATE OF ACQUISITION:!
IN TEXAS
WAS ACQUIRED
NAME OF PREVIOUS OWNER
ADDRESS
CITY
STATE
FROM ANOTHER
LEGAL ENTITY
ENTER:
ALL
WHAT PORTION OF THE BUSINESS WAS ACQUIRED?
(CHECK ONE)
PART (SPECIFY)
21.
ENTER THE YEAR(S) YOUR ORGANIZATION WAS LIABLE FOR TAXES
UNDER THE FEDERAL UNEMPLOYMENT TAX ACT:
(BEGIN WITH MOST RECENT YEAR)
(YEAR)
(YEAR)
(YEAR)
(YEAR)
(CONTINUED ON REVERSE SIDE)
C-1(1199)
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