Wisconsin Employer Report - Department Of Workforce Development - 2014
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Page 1
2014 WISCONSIN EMPLOYER REPORT
Please
complete
this
report
so
we
can
determine
if
you
must
pay
state
Unemployment
Insurance
taxes.
Return
this
report
within
10
NO
EMPLOYEES
days
unless
you
receive
different
instructions.
If
you
have
only
answer
questions
1-13,
and
sign.
Personal
information you provide may be used for secondary purposes
Privacy Law, s. 15.04(1)(m), Wisconsin Statutes
.
¨
!
<
<
Department of Workforce Development
Return to:
PLEASE COMPLETE THE NAME AND
Division of Unemployment Insurance
ADDRESS INFORMATION
UI ACCOUNT NUMBER
P.O. Box 7942
Madison, WI 53707-7942
Legal Name
Telephone (608) 261-6700
Fax: (608) 267-1400
Trade Name (DBA)
email: taxnet@dwd.wisconsin.gov
Mailing Address (c/o if required for correct delivery)
Street or P.O. Box
City
State
Zip Code
2. Name/Telephone/Email Address of Contact Person
1. Enter your Federal Employer Identification Number.
3. Business Telephone Number
4. Briefly describe your business activity
(
)
5. Location of business if different than the address shown above
8
8
6. Type of Ownership - CHECK ONE
Partnership
Limited Liability Partnership (LLP)
8
8
8
Limited Partnership
Limited Liability Co. (LLC)
Other (Estate, Trust, Receivership, Etc.)
You must provide name of general partner
8
State of Registration:
8
Please specify:
Corporation
Limited Liability Co. Electing to be
State of Incorporation:
Treated as Corp for Federal Tax Purposes
8
You must submit a copy of your IRS Notice of Acceptance
Individual
State of Registration:
6a. Provide the name(s) and social security number(s) of sole owner, partners, members or corporate officers:
% of Ownership
Name
Social Security Number
Position/Title
(Last, First, Middle Initial)
7.
For Corporations Only:
8
8
7a. Are you a non-profit organization as described in S501(c)(3) of the IRS Code?
YES
NO
If yes, you must submit a copy of the IRS determination letter of your status.
8
8
7b. Are you a Sub-Chapter S Corporation?
YES
NO
If yes, all compensation received by the officers, including dividends and other disbursements, must be shown as wages on this form.
8
8
7c. If your business is a corporation, have the officers been paid?
YES
NO
8
8
8. Have you paid employees for work performed in Wisconsin?
If yes, what is the date of first employment?
YES
NO
8
8
9. Do you expect to pay wages in the future for work performed in Wisconsin?
YES
NO
If yes, estimate the date:
8
8
10. Do you continue to have paid employees working in Wisconsin?
YES
NO
If no, date you last had employees:
8
8
11. Did you acquire any portion of an already established business?
If yes, enter date of acquisition:
YES
NO
Name of Prior Owner
Trade Name
UI Account Number
(corporate name if a corporation)
Prior Owner's Current Street Address
City
State
Zip Code
8
8
Name of New Owner
12. Did you transfer your business?
If yes, enter Date of Transfer
YES
NO
Street Address of New Owner
City
State
Zip Code
13. Do you have employees working for you outside Wisconsin?
8
8
YES
NO
14. Did you or will you have a federal unemployment tax liability on your payroll in any state in the following years?
8
8
8
8
8
8
2013
YES
NO
2014
YES
NO
2012
YES
NO
‘
CONTINUED ON NEXT PAGE
UCT-1-E (R. 11/25/2013) (U00585)
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