Form Ui/r-1 - Montana Employer Registration Form - 2001
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1AGENCY USE ONLY
MONTANA EMPLOYER
Registering for:
Employer Number
NAICS Number
REGISTRATION
Montana State Income
Mail completed form to:
Tax Withholding
Business Tax, Dept. of Revenue,
Unemployment Insurance
Industry Number
PO Box 6339, Helena, MT 59604-6339
Subject Date
WH
Fill in all spaces as they apply to your business.
Call (406) 444-6900
Questions?
Instructions are listed on the back of this sheet.
Toll-free 1-800-550-1513
Remarks
1. Business or Trade Name
4. Type of Organization:
e. Corporation
2. Owner or Corporation Name
a. Individual Ownership
f. Sub-Chapter S
b. Partnership
g. Governmental
Phone Number
3. Mailing Address
c. Limited Liability Partnership
h. Non-profit
d. Limited Liability Company
___________
i. Other
City
ZIP Code
State
5. Federal Identification
Number (FEIN):
Montana Business Location (Street Address)
Phone Number
6. Date Incorporated:
City
County
State
ZIP Code
7. Is this
seasonal
or
pension/trust ?
(Mark a box if it applies to your business)
8. IDENTIFICATION OF OWNER(S), CORPORATE OFFICERS, PARTNERS, ETC. (IF MORE THAN 3, PLEASE ATTACH A LIST)
Social Security Number
Name (Given Name Must be Shown in Full)
Title
Address (Home)
9. Name of Person Who Prepares Records and Reports
Address
Telephone No.
10. Name of Accountant
Address
Telephone No.
11. DESCRIPTION OF BUSINESS TYPE AND ACTIVITY IN MONTANA:
MUST BE COMPLETED
This section
in detail to accurately determine your business
BE SPECIFIC and check all that apply.
activity for proper assignment of contribution rates.
Generalities could result in assignment of a higher contribution rate.
Agriculture, Forestry, Fishing
Mining
Construction
Wholesale Trade
Retail Trade
Services
Finance, Insurance, Real Estate
Manufacturing
Transportation, Communication & Public Utilities
Primary Activity
Specific Product or Service
% of Gross Income
# Employees
12.
Does this establishment have employment at more than one physical location in Montana? (Exclude construction and contract work if less than six months
Yes
No
in duration.)
13.
Yes
No
Does any worksite of this establishment primarily perform management or support services for other divisions of the company?
14.
15.
Year and date payroll first equaled or exceeded
Date Employment Began
Will your total payroll for the current
Yes
No
calendar year equal or exceed $1,000?
$1,000 ______________
16. Supply the following information concerning wages paid by the current owner in Montana during the current and/or preceding year(s):
YEARS
To Date In Yr._____
Wages You Paid Each Year
17. Are you required to pay Federal Unemployment Tax (FUTA)?
Yes
No
COMPLETE QUESTIONS 18 - 23 ONLY IF YOU HAVE CHANGED YOUR BUSINESS ENTITY (SUCH AS PROPRIETORSHIP TO CORPORATION), OR
HAVE ACQUIRED A MONTANA BUSINESS OPERATION
19. How Acquired:
18. Date Changed/Acquired
Lease
e
Other, Specify:
Entity Chang
Purchased All
Purchased a Portion -- What did you purchase?
21.
Name and Address of Former Business:
20.
________________________________
Name of Former Owner(s)
22.
23.
______________________________
Former UI Account Number_______________________________
Former FEIN
Signature (Owner, all Partners or one Corporate Officer)
Title
Date
Signature
Title
Date
Return original copy to the address listed at the top of the form .
Retain one copy for your files.
UI/R-1 Rev. 7/01
6
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