Form Nys-100n - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting For Nonprofit Organizations Page 2
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4NYS 100N (02/13) page 2
8. Have you acquired all or part of the business of another employer liable for UI contributions?
Yes
No
If “Yes,” complete the following information:
a. Check one:
All was acquired
Part was acquired
b. Date of acquisition
(mmddyy)
c. Previous owner information:
1) Business name:
2) Business address:
3) Unemployment Insurance registration no.:
9. Required addresses.
9a. Mailing Address: This is your business mailing address where your Withholding Tax (WT) and Unemployment Insurance (UI)
mail will be delivered. However, if you elect to have your UI mail directed to an address other than your place of business,
complete number 9d below.
Street or PO Box: _______________________________________________________________________________
____________
City: ______________________________________________________ State: _________ ZIP Code:
9b. Physical Address: This is the physical location of your business, if different from the mailing address in 9a.
Street: ________________________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
9c. Location of Books/Records: This is the physical location where your Books and Records are maintained.
Same as 9a
Same as 9b
Other – please complete
C/O: _________________________________________________________________________________________
Street: ________________________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
Additional Addresses
9d. Agent Address (C/O): Complete this if your UI mail should be sent to an address other than your business address.
C/O: __________________________________________________________________________________________
Street or PO Box: _______________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
(
)
-
Telephone:
ext :________________
9e. LO 400 form – Notice of Entitlement and Potential Charges Address: If completed, this is where the LO 400 will be directed.
It is mailed each time a former employee files a claim for Unemployment Insurance Benefits.
Same as 9d
Other – please complete
C/O: _________________________________________________________________________________________
Street: ________________________________________________________________________________________
City: ______________________________________________________ State: _________ ZIP Code: ____________
10. List the names, Social Security Account numbers, titles and home addresses of officers.
Name
Social Security Number
Title
Residential address
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