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Form 1NP

REG NP

(rev. 6/15)

10. Date you first hired or expect to hire workers in South Dakota. _______________________________________________

10a. Date you first processed or will process payroll for workers in South Dakota? __________________________________

10b. Be advised, any remuneration to corporate officers, including dividends and disbursements in lieu of wages, is reportable.

10c. Enter below your gross quarterly payrolls. Include all wages for work performed primarily in South Dakota, paid through today’s date.

Do not include wages you expect to pay in the future.

Year

Qtr Jan. – March

Qtr April – June

Qtr July – Sept.

Qtr Oct. – Dec.

Current

Preceding

11. Have you had or will you have four (4) or more workers for 20 weeks or more in any calendar year?

Yes ( ) No ( )

Enter the ending date of the 20

week

_______/_______/________

Include all part-time employees (including day laborers) and corporate officers working for the corporation.

12. Did you acquire any portion of an already established business?

Yes ( )

No ( ) If yes, complete 12a, 12b, 12c.

12a. Name of business acquired. ___________________________________________ Owner ________________________________________

12b. Date of the acquisition? ______/______/________ SD UI account number ______________________ FEIN _________________________

If the former owner reimbursed the fund in lieu of the payment of contributions, the UI account is not transferrable to the new owner.

12c. It was agreed between you and the former owner that: All ( )

None ( )

Portion ( )

of the employer’s experience rating account

shall be acquired with the assets and liabilities following the account as provided in Section 61-5-42 SDCL. If the ownership, management or

control of the successor is substantially the same as the predecessor, a transfer of the experience rating account will be mandatory.

13.

Business Activity Information and Physical Location

If you have any questions regarding this section only, please call the Labor Market Information Center at 1.800.592.1881 or 605.626.2314.

13a. Check the box that best describes your primary business activity.

Agricultural

Transportation

Professional, Scientific,

Management of Companies

Construction

Mining

Long Distance

& Technical Services

& Enterprises

Residential Building Construction

Utilities

Local

Health Care & Social Assistance

Administrative, Support, Waste

Nonresidential Building Construction

Manufacturing

Information Services

Arts, Entertainment,

Management & Remediation Services

Specialty Trade Contractors

Wholesale Trade

Finance & Insurance

& Recreation

Educational Services

Heavy & Civil Engineering

Retail Trade

Real Estate, Rental & Leasing

Accommodations & Food

Public Administration

Construction

Other Services _______________________________________________________________________________________________________________________________________

13b. Indicate the specific activity of your business (e.g. fast food restaurant, house building). _________________________________________

13c. List physical location(s) in South Dakota. List street, city, ZIP code, and the number of workers for each location. Include home

addresses of personnel when the company does not have an office or work-site in South Dakota.

Street Address (Not a P.O. Box)

City

ZIP Code

Number of Employees in Each Location

14. Do you or will you have liability under another state’s unemployment laws in the current or preceding calendar year?

Yes ( )

No ( )

If yes, which year(s)? _____________________________________________________________

Indicate the Other States __________________________________________________________

15. We elect the following method of payment: (Choose one) If you do not choose an election, you will automatically pay contributions.

( ) 1.To pay contributions as an employer as provided in chapter 61-5 SDCL

( ) 2. Elect reimbursement of benefits in lieu of contributions as provided in chapter 61-5A-6 SDCL

( ) 3. Periodic billing for payment in lieu of contributions based on payroll as provided in chapter 61-5A-28 SDCL

SURETY BOND REQUIRED: Organizations or group of organizations electing to reimburse for benefits in lieu of contributions in elections 2 and 3

above may, at the discretion of the South Dakota Department of Labor and Regulation, be required to furnish a surety bond.

16. Your signature indicates this report is true and complete to the best of your knowledge.

_______________________________________________________________________________________________________________________________________________________________

Signature

Title

_______________________________________________________________________________________________________________________________________________________________

Print name

Date

An unemployment account will not be established until you have met the liability requirements. If you do not currently have employees but

indicate employment may begin in the future, an additional inquiry may be made to determine your liability under the unemployment laws at a

later date. You may also contact this office directly to inform the department of a change in your employment status.