Form Mdes-13 - Report To Determine Liability For Unemployment Tax - Corporation - 2001

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REPORT TO DETERMINE LIABILITY FOR UNEMPLOYMENT TAX
MINNESOTA DEPARTMENT OF ECONOMIC SECURITY - TAX OFFICE
390 ROBERT ST N
SAINT PAUL MN
55101-1812
TELEPHONE (651) 296-6141 Fax (651) 297-5283 TDD/TTY (651) 297-3944
1. Please enter your current business name and address here:
___________________
This is your current
Minnesota Unemployment
Tax Account Number (U.C.#).
IMPORTANT:
PLEASE FILL OUT FORM COMPLETELY. INCOMPLETE INFORMATION CAUSES DELAYS IN PROCESSING.
Completion of this form is required of all businesses operating in Minnesota. Additional information is available in the
Minnesota Employer's Unemployment Handbook (MDES-130) or on our Website:
2. Previous Minnesota Unemployment Tax account Number (U.C.#) if assigned __ __ __ __ __ __ __-__ __ __
3. Federal Employer Identification Number (FEIN) __ __-__ __ __ __ __ __ __
4. Business Phone Number (_______) _______-__________
E-mail Address_______________________________________
5. Type of ownership (check one)
'C' Corporation_____
'S' Corporation_____
Other: please specify_____________________
6. State of incorporation
_______________________________________
Date of incorporation
______________
7. If shares of corporate stock changed hands without formation of a new legal entity, check here: !
Effective date of change: ____________________
NOTE: CORPORATE OFFICERS WHO PERFORM SERVICES IN MINNESOTA ARE EMPLOYEES BY STATUTE.
8. Date employee(s) first performed services outside Minnesota, including corporate
Date of first services outside Minnesota
officers or shareholders. If none, enter "none".
Date of first services in Minnesota
9. Date employee(s) first performed services in Minnesota, including corporate
officers or shareholders. If none, enter "none".
10. Date first wages were paid to employees, officers or shareholders who perform
Date wages were first paid in Minnesota
services in Minnesota. If none, enter "none".
11. PHYSICAL LOCATION(S) of business in Minnesota. Do not use a post office box. Attach an extra sheet for additional locations.
Street Address
City or Township
State
Zip Code
County
# of Workers
12. Identify the industry and specific product or service which represents the greatest portion of your sales receipts or
revenue for each physical location in Minnesota.
Industry
Specific product or service
__________________________________________________________ ______________________________________________
MDES-13 CORPORATION
CONTINUED ON PAGE 2
(rev. 01-01)

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