Form Nys-100n - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting For Nonprofit Organizations

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Department of Taxation and Finance and
NYS-100N (02/13)
Department of Labor-Unemployment Insurance Div. Reg. Sec
State Office Campus, Bldg. 12
New York State Employer Registration
Albany, N.Y. 12240-0339
for Unemployment Insurance,
Withholding, and Wage Reporting for
Nonprofit Organizations
For office use only:
U.I. Employer Registration No.
Return completed form (type or print in ink) to the
address above, or fax to (518) 485-8010
Need Help? Call 1-888-899-8810
-
):
1. FEIN (Federal Employer Identification Number
(
)
-
(
)
-
2. Phone no.:
Fax no.:
3. Legal name:
4. Other name under which you operate:
5. Are you a nonprofit corporation, unincorporated association, community chest, fund, or foundation organized and operated exclusively for
religious, charitable, scientific, literary or educational purposes?
If “Yes,” complete entire form
If “No,” do not complete this form. Phone (518) 485-8589 or write to the above
Address to request form NYS-100.
Attach a copy of your exemption under the Internal revenue code 501 (C) (3). If you do not have one, attach a copy of your
exemption from New York State and local sales and use taxes, Certificate of Incorporation, Charter, Constitution or other
organizing document.
a. Enter date you began business in New York State:
(mmddyy)
b. If you have paid cash remuneration of $1,000 or more in
Jan.1 –
Apr. 1 -
Jul.1 -
Oct. 1 -
Year
total during any calendar quarter (or if you expect to pay
Mar.31
Jun. 30
Sep. 30
Dec. 31
this amount during any quarter this year), check one box
to indicate the first calendar quarter and enter the year.
1
2
3
4
c. If you employed 4 or more persons at least one day in each
Jan.1 –
Apr. 1 -
Jul.1 -
Oct. 1 -
Year
Mar.31
Jun. 30
Sep. 30
Dec. 31
of twenty weeks during a calendar year, check one box to
indicate the first calendar quarter and enter the year.
1
2
3
4
d. Do persons work for you whom you do not consider employees?
Yes
No
If “Yes,” explain the services performed and the reason you do not consider these persons employees:
6. If you are not liable under the Unemployment Insurance Law, do you want to elect
Yes
No
voluntary coverage?
7. Instead of liability on a contribution basis, do you wish to elect the option of reimbursement
Yes
No
Of benefits paid to your former employees?
If “Yes,” you must attach a copy of your exemption under the Internal Revenue code 501 (C) (3). Attach a copy of your application if your
exemption is pending.

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