Form Es 802 - Status Report
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2ES 802 (REV 1/11/99) S/N 001-0865
DO NOT WRITE IN THIS BLOCK
NEW MEXICO DEPARTMENT OF LABOR
Employment Security Division
Code:
Lia. Date
#
P.O. Box 2281 - Albuquerque, NM 87103
Cont.
Rate
Phone (505) 841-8576
Labels
Accrue
Fld. Code
STATUS REPORT: This report is required for
Qtr. Lia. Incurred
Sec. Law
all entities whether or not
ES-903's Needed
you have employment.
EE
Timely
Delq.
Date
Int.
COMPLETE ALL ITEMS ON BOTH PAGES AND RETURN WITHIN 10 DAYS.
IF ALREADY REGISTERED WITH THIS AGENCY ENTER
NO.______________________________________
Complete All Items and Return within 10 days.
1a.Fed IRS ID# (9 Digits)
b. Taxation & Revenue ID#
-
-
c. Phone # (1-800 if available)
(
)
-
2a. Legal Name (Last Name First)
b. Business Name
3a. Mailing Address (P.O. Box, Street #, Rural Route etc.)
City
State
Zip Code
b. N.M. Principal Business Location
Street
City
Zip Code
County
Phone Number
(
)
-
c. Name, Address And Phone Number where accounting records may be examined (if different from 3b.)
4. OTHER BUSINESS LOCATIONS CURRENTLY OPERATED BY THIS ENTITY IN NEW MEXICO:
GIVE TOTAL NUMBER OF BUSINESS LOCATIONS__________________
Name of Business
Location
Date Started
Nature of Business Activity
Use Additional Sheets if Necessary
5a. Type of Organization
Proprietorship
Corporation
General Partnership
Ltd. Liab. Co. (Submit Articles
of Organization or IRS Election)
Limited Partnership
Ltd. Liab. Partnership
Non-Profit
Gov.
Other_________________________________
b. State of incorporation___________________________Date___________________________NMSC NO. ______________________________
c. Owner's Name, Address, and Social Security No. (If partnership, list partners. If corporation, list officers.)
Last, First, MI
SSN
Title
Ownership %
Residence Address
6a. Provide a DETAILED description of the principal activity in New Mexico (types of products or services and primary customer, examples: construction
of single family dwelling; retail sale of children's clothing).
b. Does this business primarily perform support services for other units of the same company?
Yes
No
5
If yes, indicate type of service.
1
Central Administrative Office. 2.
Research development or testing. 3.
Storage (Warehouse)
4.
Other
9
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