Form 1np - Employer'S Report To Determine Liability For 501c3 Non Profit Organizations

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EMPLOYER’S REPORT TO DETERMINE LIABILITY
Form 1NP
REG NP
(rev. 6/15)
FOR 501c3 NON PROFIT ORGANIZATIONS
South Dakota Department of Labor and Regulation
Unemployment Insurance Division
PO Box 4730, Aberdeen, SD 57402-4730 • Phone 605.626.2312 • Fax 605.626.3347 •
This report must be completed whether or not you are liable for contributions under the South Dakota Unemployment Insurance Laws. Completion will
help determine if you must pay state unemployment insurance taxes. Return this report within 10 days unless you receive different instructions.
1.
Purpose of
( ) New Employer
( ) Reinstatement
Registration
( ) Acquired a Business
( ) Request Change to Method of Payment
(Choose one)
1a. Have you previously reported to the SD Unemployment Insurance Division? Yes ( ) No ( ) If Yes, enter account number _______________
1b. If you intend to use a TPA (Third Party Administrator), go to , complete and submit a Form POA.
Do Not Write in This Box – For SD DLR Office Use Only
2. Enter your FEIN
_
NACIS Code
Account Number
3. Business Phone (
)
Cell (
)
C – Number
Liable Date
3a. Fax Number (
)
Qualify Code
UI
Applicable Rates
Qualify Date
IF
3b. Name of Contact Person _____________________________________
Reviewer’s initials
Territory
Date
3c. Email of Contact Person
_____________________________________
Wage Successor
Wage Year
Account Code
N
P
Type of Election
Bond
3d. Email of Business ____________________________________________
Contributions
Reimbursement
Percentage
Yes
No
4. Legal Business Name (name of sole owner, partnership, corporation, limited liability company, or other)
5. Business Name or DBA
6. Primary Mailing Addresses: Your unemployment insurance tax forms and benefits mail will be delivered to your Primary Mailing Address. This
may include legal determinations and other important time sensitive information. However, you may have mail relating to unemployment insurance
benefits directed to an alternative address. See number 7.
Primary Mailing Address
Street Address or P.O. Box
City, State, Zip
Business Headquarters Location
Street Address (Not a P.O. Box)
City, State, Zip
7. Unemployment Insurance Benefits Mailing Address: If you want mail relating to unemployment insurance benefits directed to an alternative
address, please make this request on your business letterhead and include with this form.
8. Type of Ownership
1. Corporation
( )
2. Association
( )
For Corporations Date Incorporated
_____/_____/_______
(Choose One)
State of Incorporation
_______________________________
9. Identification of Principal Administrative Officers.
Social Security Number
Name
Title
Residential Address
( Not a P.O. Box)
Please complete additional questions on back of form and sign.

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