Form Deed-13 - Report To Determine Liability For Unemployment Tax - Domestic

REPORT TO DETERMINE LIABILITY FOR UNEMPLOYMENT TAX

MINNESOTA DEPARTMENT OF EMPLOYMENT & ECONOMIC DEVELOPMENT

UI EMPLOYER ACCOUNTS OFFICE - 390 ROBERT ST N - SAINT PAUL MN 55101-1812

TELEPHONE (651) 296-6141 Fax (651) 297-5283 TDD/TTY (651) 634-5062

INTERNET:

E-MAIL: deed.tax.liability@state.mn.us

1. Please enter your current business name and address here:

___________________

This is your current

Minnesota UI Employer

Account Number

IMPORTANT:

PLEASE FILL OUT FORM COMPLETELY. INCOMPLETE INFORMATION CAUSES DELAYS IN PROCESSING.

Completion of this form is required of all businesses operating in Minnesota. Additional information is available in the

Minnesota Employer's Unemployment Handbook (DEED-130) or on our Website:

2. Previous Minnesota UI Employer Account Number, if assigned

__ __ __ __ __ __ __ - ___ ___ ___

3. Federal Employer Identification Number (FEIN) __ __-__ __ __ __ __ __ __

4. Business Phone Number (_______) _______-__________

E-mail Address ________________________________________

� Individual

� Partnership

� Trust

� Non-Profit

5. Type of ownership (check one)

� Other, explain ___________________________________________

6. Date employee(s) first performed domestic services in Minnesota. If none, enter "none".

Date of first services in Minnesota

7. Date first wages were paid for domestic services performed in Minnesota. Include

Date wages were first paid in Minnesota

the fair market value of room and board provided. If none, enter "none".

Date in calendar quarter $1000 paid

8. Enter the date within the calendar quarter in which you first paid $1000 or more in

wages to domestic worker(s). Include the fair market value of room and board provided.

If none, enter "none".

Projected $1000 paid in calendar quarter

9. If you answered 'none' to question 8, enter the date that you expect to pay $1000 or

more in wages for domestic services in a calendar quarter. Enter 'never' if applicable.

10. Physical location(s) of business in Minnesota. Do not use a post office box. Attach extra sheet for additional locations.

Street Address

City or Township

State

Zip Code

County

# of Workers

Des cribe the services performed at this location: ____________________________________________________________________

11. INDEPENDENT CONTRACTOR OR EMPLOYEE?

This department renders opinions and issues formal determinations regarding classification o f workers.

�

SEND

If you have or contemplate hiring independent contractors check the box to receive information on the

INFORMATION

factors considered in making these determinations.

DEED-13 DOMESTIC

CONTINUED ON NEXT PAGE

(rev. 09-2003)

Form Deed-13 - Report To Determine Liability For Unemployment Tax - Domestic - 2003

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