Form Ncui 604 Instructions - Employer Status Report Page 2
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2Page 2 – NCUI 604 Instructions
16. EMPLOYEE LEASING
20. GOVERNMENTAL ENTITIES:
24. If the “Yes” box is checked,
COMPANIES: An employee
Check the appropriate block if
attach a list of independent
leasing company is an employee
this business is an agency or
contractor(s) who do not have a
service or temporary help service
department of federal, state or
Federal Employer Identification
that, under contract, supplies
local government.
Number. Include name(s),
individuals to perform services for
address(es), telephone number(s),
clients or customers.
and Social Security number(s).
21. Check this item to voluntarily
cover employees for
17. AGRICULTURAL
unemployment insurance, when
25. Provide for ALL general partners,
EMPLOYERS:
the business is not otherwise
principal corporate officers, or
subject to the unemployment
members full name(s), title(s),
insurance tax law.
Social Security Number(s), home
a.
Consider only monetary
address(es) (do not use a post
payments to all individuals
office box), and telephone
who performed services in
22. If the business has paid, or is
number(s) including the area
agricultural labor.
required to pay Federal
code. If additional space is
Unemployment Tax (FUTA),
needed, attach a list. Do not
check this item. Enter the calendar
provide information for limited
b.
Count any week in which as
year(s) for which FUTA is/was
partners.
many as 10 individuals were
required.
employed in agricultural
labor on any day.
Be sure all applicable items are
23. Complete this section if the
completed. Date and sign the form.
business has acquired or merged
Include the title of the person signing
18. DOMESTIC EMPLOYERS:
with another business, or any
the form. Mail the completed form to
Domestic employment includes
other changes have been made in
the address shown on page one of
all service for a person in the
the ownership of the business.
these instructions.
operation and maintenance of a
This includes changes, such as
private household, local college
from a sole proprietorship to a
club or local chapter of a college
corporation or a partnership.
fraternity or sorority. Domestic
Please call (919) 733-7156 if you have
employees include such workers
any questions.
as chauffeurs, cooks, babysitters,
a.
Enter the Name of the
gardeners, maids, butlers, and
Former Owner.
home nurses. Include only
b.
Enter the Former Owner’s
monetary payments made to
NC UI Tax Number.
individuals who performed
domestic service.
c.
Enter the Former Owner’s
Address.
19. NON-PROFIT
d.
Enter the date of the
ORGANIZATIONS: Answer this
acquisition or change.
question only if this business is a
e.
Check the appropriate box to
non- profit organization exempt
indicate if the acquisition or
from federal income tax under
change was total or partial.
Section 501(c)(3) of the Internal
Revenue Code. Attach a copy of
f.
Check the appropriate box to
the IRS letter that grants this
indicate if the business was
exemption. Non-profit
operating at the time that it
organizations with tax
was acquired. If applicable,
exemptions other than under
enter the date the business
Section 501(c)(3) should
closed.
complete item 12, general
g.
Check the appropriate box
business employment.
to indicate if the former
owner continues to have
employees.
Be sure to provide all the requested
information about the previous owner.
NCUI 604 (Rev. 12/2000)
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Parent category: Financial