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7c.

DOMESTIC EMPLOYERS: Did or will you have a quarterly domestic payroll of $1,000 or more in Virginia during the current or proceeding 3

years? Yes

. If yes, enter the earliest quarter and year: Qtr.

Yr.

. If yes, enter the date that you reached $1,000 or

NONPROFIT EMPLOYERS: Is your organization exempt from Tax under Section 501 (a) and 501 (c) (3) of the Internal Revenue Code?

YES____ NO

. If yes, attach a copy of your letter of exemption from the IRS and specify below the number of weeks during the current and

preceding 3 years you had four or more workers performing services for you for some portion of a day in Virginia: Wks.

Yr.

; Wks.

Yr.

; Wks.

Yr.

; Wks.

Yr.

. If yes, enter the date you reached the 20

week for the first time with 4 or more workers

___________.

Have you acquired a business In Virginia? Yes ______ No ______ . If yes, did you acquire all or part: All _____ Part _____ .

Date acquired: Month_____

Day____ Year _____ . From whom did you acquire the business (enter legal entity name and

trade name)? ___________________________________________________________________________________________________

Previous owner's VEC Account Number:

(See instructions on Acquisitions).

10.

Are you now or have you ever been liable for the Federal Unemployment Tax? (This is not to be confused with Social

Security or Worker's Compensation) Yes _____ No ______ . If yes, what year(s): ______________________________________

1 I.

Describe the kind of business in Virginia, giving specific details of items, customers, etc.; such as retail-women's

clothes, wholesale-office equipment, construction-single family homes. etc. (see instructions).

_______________________________________________________________________________________________________________

12.

Is the Virginia business primarily performing services for other units of the same company? Yes _____ No _____. If yes,

indicate below:

Administrative (ADM headquarlers,

Research, Development

Storage

Other

data processing centers, etc.) _______

or Testing ______

(Warehouse) _______

(Specify) _________

13.

Name the Virginia CITY or Virginia COUNTY in which business is located (specify location where work is actually performed).

_______________________________________________________________________________________________________________

14.

List Name of Owner, Partners or Corporate Officers:

NAME

SOCIAL SECURITY NUMBER

RESIDENCE ADDRESS

________________________

_________________________

_________________________________________

________________________

_________________________

_________________________________________

________________________

_________________________

_________________________________________

I certify that the information contained in this report is true and correct to the best of my knowledge.

Date: __________________

Employer’s Signature _______________________________________________________________________

****************************************************************************************************************************************************************************

VEC USE ONLY

EMP-ACCT-NO

______________

NEW-ACCT-CD

______________

TRADE-NAME-CD

______________

ADDRESS-CD

______________

HOW-LIABLE-CD

______________

CONTRBTR-CD

______________

AC-STATUS-DTE

______________

AC-STATUS-CD

______________

FIRST-EMP-DTE

______________

LIABILITY-DTE

______________

ACQ-CD

______________

COMBINED-AC-CD ______________

ACQ-DTE

______________

SUBSID-AC-NO

______________

MASTER-AC-NO

______________

WAGE-RPT-CD

______________

TYPE-BUSINESS-CD

______________

FOREIGN-CTR-CD ______________

VEC-20

______________

SUCC-ACCT-NO

______________

PRED-ACCT-NO

______________

ATTACH/EST-QTR/YR_____________

VERIFIED

______________

****************************************************************************************************************************************************************************

AREA-CD

_____________

SIC/OWN-CD

_____________

AUX-CD

______________

MULTI-PLANT-CD

_____________

****************************************************************************************************************************************************************************

SEE NEXT PAGE FOR INSTRUCTIONS

AGENCY REMARKS

FORM VEC-FC-27 INT (R 6/98)

(Source IRS Tape)

Equal Opportunity Service Provider