Form Uct-43-E - Preliminary Report - 2017 Page 2
Download a blank fillable Form Uct-43-E - Preliminary Report - 2017 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Uct-43-E - Preliminary Report - 2017 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Individuals who work EXCLUSIVELY in Wisconsin must be reported to Wisconsin for Unemployment Insurance tax
purposes. Individuals who perform services in Wisconsin on a regular basis as well as in other states MAY also be
reportable to Wisconsin under certain conditions. See the definition of "multistate employment" under point VI on the
enclosed memorandum. Based on this information, answer questions 15-18 below.
15. Do you have employees performing services exclusively in Wisconsin?
Yes
No
If yes, how many employees?
In how many weeks in 2017?
16. Do you have employees who perform services on a regular basis in Wisconsin as well as in other states?
Yes
No
If yes, how many employees?
In which states do these employees have an office branch, or other more or less permanent base from which they
operate?
From which state does direction and control over these employees' services originate?
In which state do these multistate employees have their residences?
17. Do you have employees who perform services ONLY outside of Wisconsin?
Yes
No
18. Are you a nonprofit organization described in S. 501(c)(3) of the Internal Revenue Code?
Yes
No
If yes, submit a copy of the Federal Determination Letter establishing your status under the Internal Revenue
Code with this report.
19. Does Federal Unemployment Tax (FUTA) apply to your payroll in the following years?
2016
Yes
No
2017
Yes
No
2015
Yes
No
If you have ceased activities in Wisconsin, answer questions 20-23 below.
20. What was the date of last employment in Wisconsin? (mm/dd/yyyy)
21. Were your Wisconsin operations taken over by another employer?
Yes
No
If yes, give date business transferred (mm/dd/yyyy)
22. If transferred, give name and current mailing address of new operator
Name of new operator
Street address or P.O. Box
City
State
Zip code
23. Do you expect to again have operations and employment in Wisconsin?
Yes
No
If yes, list that date here if known (mm/dd/yyyy)
Additional comments by employer on Wisconsin activities:
Section 108.24(2) provides for fines and/or imprisonment for making known false statements on this report or for
refusing to submit the completed report to this office. Your signature below indicates the report is true and
complete to the best of your knowledge and belief.
Signature
Position
Date signed
Please print name of above signature
UCT-43-E (R. 01/2017)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business