Wisconsin Employer Report - Department Of Workforce Development - 2014 Page 2
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2Page 2
2014 WISCONSIN EMPLOYER REPORT
8
8
15. Have you or will you issue 1099-Misc. forms for workers who performed service for you?
YES
NO
If yes, please list names and addresses on back of form or attach separate sheet.
16.
You
do
not
have
to
pay
UI
taxes
on
certain
persons.
The
most
common
categories
are
listed
below.
A
more
complete
list
PERMITTED EXCLUSIONS
is found under
on page 3.
16a. If you have any employees in any of the categories below check all that apply.
Partners in a general partnership.
Insurance or real estate sales people paid by commission only.
Members of a Limited Liability Company (LLC) not electing to be taxed as a corporation
Unpaid corporate officers.
for federal tax purposes.
Agricultural labor on employer's farm.
(Note: Ag. exclusion on page 3)
Other:
Other:
Indicate appropriate alphabetical letter as shown on page 3 under the heading
COMMON PERMITTED EXCLUSIONS.
Describe the exclusion if not listed under COMMON PERMITTED EXCLUSIONS:
sole proprietorship,
If your business is a
check if any of the following family members received wages from you.
16b.
8
8
Father
Child under 18 - birthdate: _______________________
8
8
Mother
Child under 18 - birthdate: _______________________
8
8
Spouse
Child under 18 - birthdate: _______________________
DO
NOT
INCLUDE
ANY
PERSON
FROM
THE
17.
In
how
many
weeks
of
2014
have
you
had
employees
either
full
or
part-time?
ABOVE
PERMITTED
EXCLUSIONS.
Please
count
the
weeks
in
which
your
employees
actually
worked,
not
the
weeks
in
which
they
were paid. A week is considered to be from Sunday through Saturday.
A. Enter the exact number of weeks through the date you are filling out this form.
B. If you have had 20 weeks, enter the week-ending date of the 20th week.
C. Enter the number of employees.
DO
NOT
INCLUDE
ANY
18.
Did
you
have
20
weeks
in
2012
or
2013
in
which
at
least
one
employee
worked
full
or
part-time?
PERSON
FROM
THE
ABOVE
PERMITTED
EXCLUSIONS.
Count
the
exact
number
of
weeks
that
your
employee
worked,
not
when
they were paid.
8
8
2012
YES
NO
8
8
If yes, week ending date of the 20th week:
2013
YES
NO
If yes, week ending date of the 20th week:
19.
Enter
your
gross
quarterly
payrolls
below.
Include
all
wages
paid
through
the
date
that
you
complete
this
report.
Do
not
estimate
the
amount
of
wages
you
expect
to
pay
in
the
future.
Show
wages
paid
only
for
work
performed
solely
or
primarily
in
Wisconsin.
DO
NOT
ENTER
THE
WAGES
OF
WISCONSIN
RESIDENTS
WHO
WORK
ENTIRELY
OUTSIDE
OF
WISCONSIN.
DO
NOT
INCLUDE
WAGES PAID TO PERSONS FROM THE ABOVE PERMITTED EXCLUSIONS.
1st QTR. JAN.-MARCH
2nd QTR. APRIL-JUNE
3rd QTR. JULY-SEPT.
4th QTR. OCT.-DEC.
2012
2013
2014
20. Name and address of financial institution through which you will maintain your business checking account.
Name
Street Address
City/State
Checking Account Number
Your signature indicates this report is true and complete to the best of your knowledge.
Signature
Position
Please print name of above signature:
Date Signed
‘
CONTINUED ON NEXT PAGE
Print Form
Clear Form
(U00586) (R. 01/28/2014)
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