Status Report Form - Texas Workforce Commission Page 2
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1
2Farm & Ranch Employment Section - Continued
MO.
DAY
YEAR
22.
A. Enter the date your organization resumed employing someone on a farm or ranch in Texas.
If your account
has been inactive:
B. Enter the date your organization resumed paying wages in Texas.
23.
PREVIOUS OWNER'S TWC ACCOUNT NUMBER (IF KNOWN)
If the business
Date of Acquisition
in Texas was
acquired from a
NAME OF PREVIOUS OWNER
ADDRESS
CITY
STATE
previous owner,
enter:
All
What portion of the business was acquired? (Check one)
Part (Specify)
Nature of Business
24.
Describe fully the nature of activity
in Texas and list the principal
products or services in order
of importance
.
25.
Enter in the box below the code number of the item that most closely describes the nature of your farm and ranch operations in Texas.
CODE
DESCRIPTION
111
Crop Production
112
Animal Production
115
Agriculture and Forestry Support Activities
Voluntary Election Section
26.
If you are not liable under a compulsory provision of the Texas Unemployment Compensation Act, and you wish to voluntarily elect coverage for
your employees, select one of the following and enter the year you wish liability to begin.
All employees
All employees, except those performing services which are specifically exempt in the Texas Unemployment Compensation Act
Beginning January 1,
it is understood and agreed that at the end of two years from this date, or at the end of any calendar year
YR
subsequent thereto, you may withdraw this election by filing a written request.
If this election is approved, we will notify you of your account number.
Signature Section
27.
I hereby certify that the preceding information is true and correct and that I am authorized to execute this status report on behalf of the employing
unit named herein. (This report must be signed by the owner, officer, partner or individual for whom a valid Written Authorization is on file with the
Texas Workforce Commission.)
SIGN
MO.
DAY
YEAR
ð
HERE
DATE SIGNED
Signature
Title
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