Form Sr2 - Application To Determine Liability

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STATE OF ALABAMA
DEPARTMENT OF LABOR
UNEMPLOYMENT COMPENSATION DIVISION
649 MONROE STREET
MONTGOMERY, ALABAMA 36131
STATUS UNIT: (334) 242-8830 FAX: (334) 242-2067
APPLICATION TO DETERMINE LIABILITY
IMPORTANT NOTICE
Under Alabama law you are required to furnish the information requested on this application.
Each false statement or refusal to furnish information on this report, or willful
refusal to make contributions or other payments is punishable by fine or imprisonment, or both, and each day of such refusal shall constitute a separate offense.
EMPLOYER NAME AND MAILING ADDRESS
FEDERAL EMPLOYER I.D. NUMBER (FEIN)
This number is assigned by the Internal Revenue Service
1.
Mark (x) one type of employment. A separate form must be filed for each type of employment.
NON-FARM
AGRICULTURE
DOMESTIC
GOVERNMENT: STATE
LOCAL
YES
NO
2.
Do you have a previous Alabama Unemployment Compensation Account?
2a. If yes, account number:
YES
NO
3.
Do you have employees located in another state?
3a. If yes, in what state(s)?
YES
NO
4.
Is your firm subject to the Federal Unemployment Tax Act (FUTA)?
4a. If yes, year liability first incurred:
YES
NO
4b. Have you remained liable since that date?
YES
NO
YES
NO
5.
Did you start a new business?
5a. If no, did you acquire an ongoing business?
5b. Date Alabama employment began:
ALL
PART
or
6.
If you acquired
of an ongoing business, enter the NAME,TRADE TITLE and ADDRESS of your predecessor
employer:
6a. Predecessor's telephone number (if known):
6b. Predecessor FEIN (if known):
6c. If your predecessor was liable in Alabama, enter their Alabama Unemployment Account Number (if known):
YES
NO
6d. Date acquired from predecessor:
6e. Did your predecessor discontinue business?
6f. If yes, date discontinued:
7.
List below TOTAL ALABAMA WAGES paid to all employees during each calendar quarter of each year from the date in Item 5b.
Include remuneration paid to officers of corporations and wages of part-time employees for current year and previous year,
if applicable.
JAN-FEB-MAR
APR-MAY-JUN
JUL-AUG-SEP
OCT-NOV-DEC
CURRENT
YEAR:
PREVIOUS
YEAR:
8. List below, by type of employment, the number of individuals in your employ within each week. A month with five Saturdays is
considered to have five weeks of employment. Include all part-time employees and officers remunerated by corporations.
WEEK
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
1st
2nd
Current
Year
3rd
4th
5th
WEEK
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
1st
2nd
Previous
Year
3rd
4th
5th
FORM SR2 (Rev. 6-2012),
IMPORTANT: Please complete this application, Questions 1-14.
PAGE 1 OF 2
CAT NO 53270

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