Form Deed-13 - Report To Determine Liability For Unemployment Tax - Agricultural - 2003 Page 2
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2REPORT TO DETERMINE LIABILITY FOR UNEMPLOYMENT TAX (continued)
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Write in your Minnesota UI Employer Account Number:
12. 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
13. Identify the industry and specific product or service which represents the greatest portion of your sales receipts or
revenue for each physical location in Minnesota.
Industry
Specific product or service
__________________________________________________________
______________________________________________
14. INDEPENDENT CONTRACTOR OR EMPLOYEE?
This department renders opinions and issues formal determinations regarding classification of workers.
If you have or
contemplate hiring independent contractors check the box to receive information on the
�
SEND
factors considered in making these determinations.
INFORMATION
15. OWNERSHIP INFORMATION:
Please print or type.
This report must be signed by the owner, all partners or authorized officers.
Attach additional sheet if needed.
I certify that information on this form is true to the best of my knowledge.
Full Legal Name
Title
SSN
% of Ownership
Home Address
City
State
Zip Code
Signature
Phone #
Date
Full Legal Name
Title
SSN
% of Ownership
Home Address
City
State
Zip Code
Signature
Phone #
Date
Phone #
Date
16. Form prepared by:
The Purpose of the DEED-13
Information you provide on this form will be used for the purpose of determining your liability to pay into the unemployment fund under
the Minnesota Unemployment Insurance Law and other purposes authorized by law. This information is required under MN Statutes
268.043 and 268.186. Information you supply may make you liable for (1) a tax on your payroll if you are a private employer; or (2) the
reimbursement of unemployment benefits paid to your ex-employees if you are a public or nonprofit employer. Not supplying this
information could result in the assessment of taxes, interest and penalties as set forth under Minnesota Statute 268.057. Information
you furnish will be released to the Internal Revenue Service to certify the amount of employment taxes you paid this State for which you
are requesting a credit against the tax imposed by Section 3301 of the Federal Unemployment Tax Act and for such purpose and to
such entities as set forth in Minnesota Statute 268.19.
DEED-13 AGRICULTURAL
(rev. 9-2003)
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