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Form Deed-591 - Voluntary Election To Extend Coverage To Corporate Officers And Limited Liability Company Members Under Minnesota Ui Law

VOLUNTARY ELECTION TO EXTEND COVERAGE TO CORPORATE OFFICERS

AND LIMITED LIABILITY COMPANY MEMBERS UNDER MINNESOTA UI LAW

MINNESOTA DEPARTMENT OF EMPLOYMENT & ECONOMIC DEVELOPMENT

UI EMPLOYER SERVICES OFFICE

1st National Bank Bldg, 332 Minnesota Street, Suite E200, Saint Paul, MN 55101-1351

v FAX (651) 297 -5283

v TDD/TTY (651) 634 -5062 / (877) 360 -1919 toll-free

TELEPHONE (651) 296 -6141

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

Note: This form pertains ONLY to corporations and limited liability companies

Legal Name of Corporation

or Limited Liability Company: _____________________________________________________

Minnesota UI Employer Account Number: ________________________

Owners/Officers

(only those with 25% or more ownership are impacted by this election):

First Name

MI Last Name

SSN

% Owned

Effective January 1, 2005, Minnesota UI Law Section 268.035 Subd.20 (28) excludes from covered

employment corporate officers and members of limited liability companies who own 25% or more of

the employer corporation or limited liability company. A written election must be filed if you wish to

cover these individuals for unemployment purposes.

I elect to cover all corporate officers or limited liability company members with 25% or more

ownership effective ______________. Unemployment taxes will be paid on the wages paid

to these owners.

I do NOT elect to cover officers or members who own 25% or more of this business. However,

there ARE other employees to report.

I do NOT elect to cover officers or members who own 25% or more of this business. There are

NOT any other employees to report.

I certify that I am an authorized representative of the employer described above, and have the authority to

make this election. I understand that this election will remain in effect for a minimum of two (2) years. After

that, it may be terminated by filing a written notice at least thirty (30) days prior to the first day of January of

any subsequent year. I understand that we need to notify this department of changes in officer or member

ownership, including percentage of ownership.

Signature:

__________________________ ____

Date: ______________

Title:

______________________________

Phone number:

______________________________

e-mail address:

______________________________

DEED -591

Remit this form to the address or fax number above.

(DEED-00593) (1-05)

Form Deed-591 - Voluntary Election To Extend Coverage To Corporate Officers And Limited Liability Company Members Under Minnesota Ui Law

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