Form Es 802 - Status Report Page 2
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27. Non-profit organizations, hospitals, schools, municipalities, and counties-Are your applying for Reimbursable Cost Basis financing?
Yes
No If yes, submit Certificate of Federal Exemption, 501(c)(3), and Form ES-802-0.
8a. Provide the amount of wages paid for each quarter for the last 16 quarters. If No wages have been paid, please indicate so.
If you are a new employer and wages have not been paid, please ESTIMATE when wages will be paid and the amount anticipated.
Please indicate if they are estimated amounts. If no wages are anticiapated, please indicate "No Employees" or "No Wages Anticipated"
(N/A will not suffice) Item 8a must correspond with item 12.
Enter Year
First Quarter
Second Quarter
Third Quarter
Fourth Quarter
Total Wages
Enter Year
First Quarter
Second Quarter
Third Quarter
Fourth Quarter
Total Wages
Enter Year
First Quarter
Second Quarter
Third Quarter
Fourth Quarter
Total Wages
Enter Year
First Quarter
Second Quarter
Third Quarter
Fourth Quarter
Total Wages
Enter Year
First Quarter
Second Quarter
Third Quarter
Fourth Quarter
Total Wages
8b.
Does your business consist soley of AGRICULTURAL employment?
Yes
No
c.
Does your employment consist soley of DOMESTIC workers?
Yes
No
d.
Excluding AGRICULTURAL and DOMESTIC employment, did you employ one or more persons in each of 20 weeks of any calendar year
listed in 8a? Yes__________No__________ If yes, enter month and year of twentieth week. __________________________
e. If AGRICULTURAL, did you have ten (10) or more employees during 20 weeks of any calendar year listed in 8a? Yes__________No_______
If yes, enter month and year of twentieth week.______________________________
9.
If you claim exemption for any persons performing services in New Mexico, furnish reason(s). Are these included in Item 8?
Yes___________No____________ (If yes, give reasons)
10.
Are you liable for the tax imposed under FUTA?____________
11
Date you acquired or started the business in New Mexico.____________________________
12.
Date you first paid wages in New Mexico._____________________
13.
If you acquired the business, furnish name, address, and account number of predecessor.
14.
Did the predecessor continue to operate another business in New Mexico? Yes_________No_________ (If item 13 is completed you must
15.
Are you now or have you ever been registered with this Division?_____________________
answer item 14)
If so, your account Number is/was____________________________
16.
I hereby certify that all the information given in this report is true and correct to the best of my knowledge and belief.
Signature/Title
Date
FAILURE TO COMPLETE FORM ES-802 IN ITS ENTIRETY WILL RESULT IN RETURNING THE FORM TO YOU AND
CAUSE DELAY IN PROCESSING.
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