Form Dr-1 - Application To Collect And/or Report Tax In Florida (2001) (Page 4 of 5) in pdf

DR-1

SECTION D — UNEMPLOYMENT TAX

R. 08/01

Page 4

In order to simplify registration, the Department of Revenue (DOR) has combined the traditional tax and unemployment tax applications. DOR is required by law to provide unemployment tax

information to the Agency for Workforce Innovation (AWI), a State of Florida agency. By signing in Section H below, you authorize DOR to release this application to AWI. If you do not want this

application to be provided to AWI, place an “X” in the box labeled, “DO NOT SHARE WITH AWI,” at the top of Page 1. You will then be required to complete a separate Employer Registration Report

(Form UCS-1), which DOR will provide to AWI. AWI is required by law to keep confidential all tax registration information it receives from DOR.

31.

Employer type (check all that apply)

Regular

Agricultural (citrus)

Nonprofit organization

501(c)(3) letter must be attached

Domestic (household)

Agricultural (non citrus)

Governmental entity

Agricultural crew chief

Indian tribe / Tribal unit

32.

Did your business pay federal unemployment tax in another state in the current or previous calendar year? ..........................

Yes

If yes, in which state(s) ___________________________________________

Year(s) _____________________________________________

33.

Do you use the services of individuals in Florida whom you consider to be self-employed? ...................................................

Yes

If yes, describe the services performed. ______________________________________________________________________________________

_____________________________________________________________________________________________________________________

34.

For the current calendar year, how many full or partial weeks have you employed workers? ____________________________________________

For the previous year, how many full or partial weeks did you employ workers? _____________________________________________________

35.

Provide the date that you first employed workers in Florida.

month

day

year

36.

Does another party (accountant, bookkeeper, agent) maintain your payroll? ...........................................................................

Yes

If yes, provide the following information.

Name of agent _________________________________________

Telephone number _____________________________________________

Address ______________________________________________

City/State/ZIP ________________________________________________

37.

Provide your Florida gross payroll by calendar quarters. Estimate amounts if exact figures are not available.

Qtr Ending 3/31

Qtr Ending 6/30

Qtr Ending 9/30

Qtr Ending 12/31

Current year

Previous year

Next previous year

38.

Did you purchase this business from another entity? ................................................................................................................

Yes

If no, did you:

incorporate?

form a partnership?

become a sole proprietorship?

If yes, provide the following:

•

Complete items a through h below, providing information about the former owner.

•

Complete and submit a Report to Determine Succession and Application for Transfer of Experience Rating Records (Form UCS-1S) to the

Department of Revenue. This form must be postmarked within 90 days of the acquisition date to be considered timely.

a. Legal name of former owner ___________________________________________________________________________________________

b. FEIN ______________________________________________

c. UT employer account number _________________________________

d. Trade name (d/b/a) ___________________________________________________________________________________________________

e. Address ____________________________________________________________________________________________________________

f. Date acquired _______________________________________

g. Portion of business acquired:

All

Part

Unknown

h. Was the business in operation at time of acquisition?

Yes

If no, provide date business closed. _____________________________

39.

List the locations and nature of business conducted in Florida. Use additional sheets if necessary.

City and county of work site

Principal products / services

Number of employees

________________________________________

_____________________________________________

____________________________

________________________________________

_____________________________________________

____________________________

________________________________________

_____________________________________________

____________________________

________________________________________

_____________________________________________

____________________________

Do the above work sites provide support for any other units of the company? .........................................................................

Yes

If yes, the services are:

administrative

research

other, specify ___________________________________________________________

______________________________________________________________________________________________________________________

FOR DOR OFFICE USE ONLY

UT Employer Acct No.

Effective Date

Established Date

SIC

Form Dr-1 - Application To Collect And/or Report Tax In Florida (2001) Page 4

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