Preliminary Report For 2014 Page 2
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1
2Individuals
who
work
EXCLUSIVELY
in
Wisconsin
must
be
reported
to
Wisconsin
for
Unemployment
Insurance
tax
purposes.
Individuals
who
perform
services
in
Wisconsin
on
a
regular
basis
as
well
as
in
other
states
MAY
also
be
reportable
to
Wisconsin
under
certain
conditions.
See
the
definition
of
"multistate
employment"
under
point
VI
on
the
enclosed
memorandum. Based on this information, answer questions 16-18 below.
Yes
No
15.žDo you have employees performing services exclusively in Wisconsin
.....................................................................
If yes, how many employees?
....................................................................................................................................................
____________
In how many weeks in 2014?
.......................................................................................................................................................
____________
16.žDo you have employees who perform services on a regular basis in Wisconsin as
Yes
No
žžžwell as in other states?
.........................................................................................................................................................................
žžžžžžžIf yes, how many employees?
.....................................................................................................................................................
____________
žžžžžžžIn which state do these employees have an office, branch, or
žžžžžžžžother more or less permanent base from which they operate?
.......................................................................
____________
žžžžžžžFrom which state does direction and control over these employees' services originate?
....................
____________
žžžžžžžIn which state do these multistate employees have their residences?
............................................................
____________
17.žDo you have employees who perform services ONLY outside Wisconsin?
...............................................................
Yes
No
18.žAre you a nonprofit organization described in S.501(C)(3) of the Internal Revenue Code?
.........................
Yes
No
žžžžžIf yes, submit a copy of the Federal Determination Letter establishing your status under the
žžžžžInternal Revenue Code with this report.
19.žWill the Federal Unemployment Tax apply to your
2014 payrolls?
...............................................................
Yes
No
total
Did it apply to your 2013 payrolls?
...........................................................................................................................................
Yes
No
Did it apply to your 2012 payrolls?
...........................................................................................................................................
Yes
No
If you have ceased activities in Wisconsin, answer questions 20-23 below.
20.žWhat was the date of last employment in Wisconsin? (mo./day/yr.)
.....................................................................
____________
Yes
No
21.žWere your Wisconsin operations taken over by another employer?
...........................................................................
žžžžžIf yes, give date business transferred (mo./day/yr.)
........................................................................................................
____________
22.žIf transferred, give name and current mailing address of new operator:
________________________________________________________________
23.žDo you expect to again have operations and employment in Wisconsin?
.............................................................
Yes
No
žžžžžIf yes, list that date here if known (mo./day/yr.)
...........................................................................................................
____________
žžžžAdditional comments by employer on Wisconsin activities:
Section
108.24(2)
provides
for
fines
and/or
imprisonment
for
making
known
false
statements
on
this
report
or
for
refusing
to
submit
the
completed
report
to
this
office.
Your
signature
below
indicates
the
report
is
true
and
complete
to
the
best
of
your
knowledge
and
belief.
Signature
Position
Date
Signed
(U00022)
(R.
01/28/2014)
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