Form 48812 - Indiana Business Locations - 2015
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INDIANA BUSINESS LOCATIONS
State Form 48812 (R2 / 4‐15)
INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT
10 N Senate Ave RM SE 202
Indianapolis, IN 46204‐2277
Confidential record pursuant To IC 4‐1‐16, IC 22‐4‐19‐6
* This agency is requesting disclosure of Social Security Numbers (SSNs) in accordance with IC 4‐1‐8‐1; disclosure is mandatory and this record cannot be processed without it.
IMPORTANT: Employers that have multiple work locations in Indiana are required to provide the address of the locations where work
is being performed. Employers may also designate one each (1) specific address to be used for benefit notifications or collections
notices that is, or is not, an Indiana worksite location. All other addresses should be in Indiana. This form is used to create or amend
location codes for the employer. If you are a single employing unit reporting for multiple FEINs, this form is required for proper
in.gov/dwd/SUTA.
htm
administration of the account. Please go to www.
for additional information or clarification.
SECTION ONE – IDENTIFICATION OF THE EMPLOYER
What is the SUTA number currently assigned to the business you are reporting?
What is the name of this business as registered with IDWD?
What is the FEIN number of this employer as registered with IDWD?
Select filing type:
Create Locations
Amend Locations
SECTION TWO – LOCATIONS (Additional forms may be completed as needed.)
1. Name
Current location code (amend):
FEIN if different from Primary FEIN:
Street
City
State
ZIP
‐
US
Canada
Mexico
Other
Ext or
‐
‐
Telephone
Name
Type of location:
Indiana Work Site
Benefit Mailing
Collection Mailing
2. Name
Current location code (amend):
FEIN if different from Primary FEIN:
Street
City
State
ZIP
‐
US
Canada
Mexico
Other
Ext or
‐
‐
Telephone
Name
Type of location:
Indiana Work Site
Benefit Mailing
Collection Mailing
3. Name
Current location code (amend):
FEIN if different from Primary FEIN:
Street
City
State
ZIP
‐
US
Canada
Mexico
Other
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