Form Uct-43 - Preliminary Report - 2000 Page 2

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

VII

on

the

enclosed

memorandum.

Based on this

information,

answer

questions

16-18

below.

16. Do you have employees

performing

services

exclusively

in Wisconsin..

.................................................................

q

Yes

ON0

If yes, how

many employeesl..

i.

...................................................................................................................... ..............................

In how

many

weeks

in 2000? .......................................................................................................................................................

17. Do you have employees

who

perform

services

on a regular

basis

in Wisconsin

as

well

as in other

states?. ................................................................................... .;. ..................................................................................

q

Yes

q

No

If yes, how

many employees2.. .................................................................................................................................................

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

originate2 ..................

In which

state

do these

multistate

employees

have their

residences? _. .........................................................

18. Do you have employees

who

perform

services

ONLY outside

Wisconsin2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..“....................

q

Yes

ONo

19. Are you a nonprofit

organization

described

in !ZOl(C)(3)

of the Internal

Revenue

Code? . . . . . . . . . . . . . . . . . . . . . . . . .

q

Yes

q

No

If yes, submit

a copy of the Federal

Determination

Letter

establishing

your status

under the

Internal

Revenue

Code with

this

report.

20. Will

the Federal

Unemployment

Tax apply

to your

total

2000

payrolls?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

[7Yes

ONo

Did it apply

to your

1999 payrolls?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...................

•Yes

~NO

Did it apply

to your

1998 payrolls?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...................

OYes

[7No

If you have ceased

activities

in Wisconsin,

answer

questions

21-24

below

21. What

was

the date of last employment

in Wisconsin?

(mo./day/yr.).

....................................................................

22. Were

your Wisconsin

operations

taken

over by another

employer?.

..........................................................................

q

]Yes

q

NO

If yes, give

date business

transferred

(mo./day/yr.j

........................................................................................................

23. If transferred,

give name

and current

mailing

address

of new

operator:

24. Do you expect

to again

have operations

and employment

in Wisconsin?

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

[ZjYes

ONo

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

or for

refusing

to sutimit

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

:Uooo22)

m. 1 l/24/99)