Form Modes-2699-5 - Unemployment Tax Registration
Download a blank fillable Form Modes-2699-5 - Unemployment Tax Registration 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 Modes-2699-5 - Unemployment Tax Registration 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
2FOR DIVISION USE ONLY
MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
SUTA
DIVISION OF EMPLOYMENT SECURITY
LIA 2699(
) ID
UNEMPLOYMENT TAX REGISTRATION
The Division of Employment Security (DES) has received information showing you are a
potential employer in Missouri. For this reason you are being provided this form.
MAILING BLOCK
MAILING ADDRESS IF DIFFERENT:
FEIN#
DOR#
Phone Number
E-mail
Tax Preparer
Billing
Headquarters
If you need help completing this form or have questions visit our website at ,
e-mail esemptax@labor.mo.gov, call 573-751-3340, or fax 573-751-7483
MAIN BUSINESS IN MISSOURI
GENERAL
Construction – Residential
Transportation
Utilities
Food Services
Financial Services
Retail Sales – New
Construction – Commercial
Mortgage
Health Services
Mining
Retail Sales – Used
Wholesale
Manufacturing
Trucking
Other _____________________
AGRICULTURAL
Crop
Animal
Other _____________________
DOMESTIC
Household
Caretaker
Nanny
CDS Provider
Other _____________________
BUSINESS TYPE
Individual
Corporation
LLC Sole Proprietor
LLC Corporation
Association
Partnership
Limited Partnership
LLC Partnership
LLP
Other _____________________
If registered, provide charter information
State __________
Charter # _________________________
Charter Date ____________________
/
/
EMPLOYMENT INFORMATION
First Date of Worker in Missouri ____________________
/
/
First Date of Missouri Payroll ____________________
/
/
EMPLOYER TYPE
General
Domestic
Religious
Local Government
Agricultural
Lessor/PEO
State
Indian Tribe
Do you wish to be a reimbursable employer?
501C(3)
Yes
No
ENTER WAGES PAID:
Year
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Did you employ workers during 20 weeks in a calendar year?
Yes
No
If “Yes,” number of workers? __________
Quarter _______ and Year _______ of 20th week.
If you have not hired a Missouri worker, when do you anticipate hiring worker(s) in Missouri? __________________________________________
If no Missouri workers, please explain: ____________________________________________________________________________________
(CONTINUE ON NEXT PAGE)
MODES-2699-5 (01-14) AI
Cont.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal