Form Uct-43 - Preliminary Report - 2013 (Page 2 of 2) in pdf

Individuals 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

15. Do you have employees performing services exclusively in Wisconsin.....................................................................

If yes, how many employees? .................................................................................................................................................... ____________

In how many weeks in 2013? .......................................................................................................................................................

____________

16. Do you have employees who perform services on a regular basis in Wisconsin as

Yes

well as in other states? .........................................................................................................................................................................

If yes, how many employees?

..................................................................................................................................................... ____________

In which state do these employees have an office, branch, or

other more or less permanent base from which they operate?

....................................................................... ____________

From which state does direction and control over these employees' services originate?

.................... ____________

In which state do these multistate employees have their residences?

............................................................ ____________

17. Do you have employees who perform services ONLY outside Wisconsin?...............................................................

Yes

18. Are you a nonprofit organization described in S.501(C)(3) of the Internal Revenue Code? .........................

Yes

If yes, submit a copy of the Federal Determination Letter establishing your status under the

Internal Revenue Code with this report.

19. Will the Federal Unemployment Tax apply to your

2013 payrolls?...............................................................

Yes

total

Did it apply to your 2012 payrolls? ...........................................................................................................................................

Yes

Did it apply to your 2011 payrolls? ...........................................................................................................................................

Yes

If you have ceased activities in Wisconsin, answer questions 21-24 below

20. What was the date of last employment in Wisconsin? (mo./day/yr.) ..................................................................... ____________

Yes

21. Were your Wisconsin operations taken over by another employer? ...........................................................................

If yes, give date business transferred (mo./day/yr.)

........................................................................................................ ____________

22. If transferred, give name and current mailing address of new operator:

________________________________________________________________

23. Do you expect to again have operations and employment in Wisconsin? .............................................................

Yes

If yes, list that date here if known (mo./day/yr.)

........................................................................................................... ____________

Additional comments by employer on Wisconsin activities:

Section 108.24(2) provides for fines and/or imprisonment for making known false statements on this report