Form Uco-1 - Report To Determine Liability printable pdf download

Form Uco-1 - Report To Determine Liability

1.a. Employer Name

(ZIP)

(zip)

IJ Corporation: (state of inc.)

0 Other (explain):

S.S. #

0 Yes

0 N o

0 Yes 0

0 Yes

0 No

0 Central Administratrve Office

0 Storage (warehouse)

0 Research, Development or Testing

(R 1-96)

1-96)

OHIO BUREAU OF EMPLOYMENT SERVICES

Attention: Contribution Department

145 South Front Street P.O. Box 923

Columbus, Ohio 43216-0923

(614) 466-2319

REPORT TO DETERMINE LIABILITY

1 .b. Employer Trade Name (if any)

1 .c. Telephone #

(state)

1 .d. Business Address

(street)

(city)

1 .e Mailing Address (if different) (street)

(state)

(city)

2.a. Type of business operation:

Individual 0 Partnership 0 Association

Joint Venture 0 Limited Liability Company

(date of inc.)

(charter #)

Fiduciary (type):

2.b. Provide the following information regarding the employer’s principal members (individual, partners, corporate officers, etc.). (If not sufficient

space, attach supplemental sheet.)

Name

Home Address

3.a. On what date did you begin operations in Ohio?

3.b. On what date did you first employ one or more workers in Ohio?

(include corporate officers)

4. Was the business previously operated by another employer?

5.a. Have you previously been subject to the Ohio Unemployment

Compensation Law?

5.b. If yes, provide: (name)

(OBES account #)

6. Provide your federal employer identification # (I.R.S.)

7.a. Have you paid wages which were taxable under the

7.b. If yes, indicate which years.

Federal Unemployment Tax Act (FUTA)

6.b. If yes, attach a copy of the exemption letter Issued by the

6.a. Is your enterprise exempt from federal income taxes under

section 501 (c)(3), Internal Revenue Code?

Internal Revenue Service.

9. If your business requires a liquor permit, provide permit #.

10.a. Describe fully the type of business you operate. Do you have more than one place of business or employment in Ohio?

OHIO County in which

Number of Workers

Materials Used

Nature of business, including services performed and

workers are employed

products manufactured or sold. (If engaged in trade,

(If manufacturing)

indicate retail or wholesale).

Yes

10.b. Is the establishment primarily engaged in performing services for other units of the company?

If “YES”, indicate nature of activity:

Other (specify)

NOTE: If you have any questions in regard to questions 10.a. or lO.b., please telephone (614) 644-2689.

uco-1

White

OBES Copy Yellow

Employer Copy

SES 0029

0029

6 6 3 0 0

Form Uco-1 - Report To Determine Liability

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