Form Deed-13 - Report To Determine Liability For Unemployment Tax
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2REPORT TO DETERMINE LIABILITY FOR UNEMPLOYMENT TAX
Minnesota Department of Employment & Economic Development - UI Employer Accounts
390 ROBERT ST. N. ¤ ST PAUL, MN 55101
Tel: (651) 296-6141 ¤ Fax: (651) 297-5283 ¤ TDD/TTY:(651) 634-5062
1.
Please enter your current business name and address here:
2.
Current or previous Minnesota Unemployment
-
Tax Account Number (SUTA#) if assigned:
3.
Federal Employer Identification Number (EIN):
-
4.
Business Telephone Number:
(_______)__________________
5.
Type of Ownership (check one):
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Individual
Partnership
‘ C’Corporation
‘ S’Corporation
Limited Liability Company (LLC)
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Nonprofit 501(c)(3)
Trust
Political Subdivision
Other:
6.
Date business was organized or
State of Incorporation
incorporated:
(if applicable):
7.
PHYSICAL LOCATION(S) of business in Minnesota.
Please give street address.
Attach an extra sheet for additional locations.
Street Address
City or Township
State
Zip Code
County
Number of Workers
8.
Identify the INDUSTRY and the 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
NOTE:
ALL CORPORATE OFFICERS ARE EMPLOYEES BY STATUTE.
Date of first services outside MN
9.
Date employee(s) first performed services outside Minnesota.
If none, enter
“ none.”
Date of first services in MN
10.
Date employee(s) first performed services in Minnesota.
If none, enter
“ none.”
Date of first MN wages
11.
Date first wages were paid for services performed in Minnesota.
If none, enter
“ none.”
th
Date 20
week in cal year in MN
th
12.
501(c)(3) Employers:
Date of the 20
week in a calendar year in which services were
performed in Minnesota.
Attach a copy of your federal tax exemption letter.
13.
Date $1,000 in calendar quarter
Domestic: (Complete only if you have or had household employment.) Date you first paid
A.
$1,000 or more in wages during a calendar quarter to domestic employee(s) anywhere in the
United States.
Include the value of room and board provided.
If none, enter
“ none.”
Date of first services in calendar
year
B.
If $1,000 quarter reached, date of first services performed in calendar year entered in #13A.
Date of first wages in calendar year
C.
If $1,000 quarter reached, date of first wages paid in calendar year entered in #13A.
14.
Agricultural:
(Complete only if you have or had agricultural employment.)
4 MN employees during 20 wks
A.
Date you had four or more employees in Minnesota during 20 different weeks in a calendar
year, excluding officers of a family farm corporation.
If none, enter
“ none.”
10 US employees during 20 wks
B.
Date you had ten or more employees during 20 different weeks in a calendar year anywhere in
the United States, including officer of a family farm corporation.
If none, enter
“ none.”
C.
Date your business paid $20,000 gross payroll in a calendar quarter to agricultural employees
Date $20,000 in calendar quarter
anywhere in the United States (including noncash wages in Minnesota).
If none, enter
“ none.”
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15.
Independent Contractor or Employee? This department renders opinions and issues determinations
Send information
regarding classification of workers.
If you have or contemplate hiring independent contractors, check
the box to receive information on the factors considered in making these determinations.
INTERNET:
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E-MAIL: deed.tax.liability@state.mn.us
DEED-13 (REV. 9-2003)
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