Form Nys 100 New York State Employer Registration (Page 3 of 4) in pdf

Enter legal name

For office

use only

Part E - Business Information (continued)

2. For each of your establishments in New York State, answer A-E below. Use a separate sheet for each establishment.

Location

No. and Street

City or Town

County

ZIP Code

B. Approximately how may persons do you employ there?

C. Check the principal activity at the above location.

Manufacturing

Transportation

Scientific/professional & technical services

Wholesale trade

Computer services

Finance and insurance

Retail trade

Educational services

Arts, entertainment, & recreation

Construction

Health & social assistance

Food service, drinking, & accommodations

Warehousing

Real estate

Corporate, subsidiary managing office

Other (Please specify)

D. If you are primarily engaged in manufacturing, complete the following:

Principal Products Produced

Percent of Total Sales Value

Principal Raw Materials Used

E. If your principal activity is not manufacturing, indicate products sold or services rendered:

Type of Establishment

Principal Product Sold or Service Rendered

Percent of Total Revenue

I affirm that I have read the above questions and that the answers provided are true to the best of my knowledge and belief.

Signature of Officer, Partner, Proprietor, Member or Individual

Official Position

Date

Instructions

General Information:

If you are a business employer or a household employer of domestic services, complete and return Form NYS-100.

If you are a nonprofit, agricultural, or governmental employer, do not complete Form NYS-100. Phone (518) 485-8589 or write to the address

on page one of this form to request information and necessary forms.

Voluntary Coverage for U.I. purposes - if you are not liable for UI tax but want to provide voluntary coverage for employees, phone

(518) 457-2635.

Part A

Item 3

Enter your nine digit Federal Identification Number. This number is used to certify your payments to the IRS under the Federal

Unemployment Tax Act.

Item 6 - 7 Enter the legal name of the employer and the trade name, firm name, registered name, etc., if any, used for business purposes. If

the employer is a partnership, enter the full name of each partner. If the employer is a corporation, enter the corporate name

shown in its Certificate of Incorporation or other official document. In the case of an estate of a decedent, insolvent, incompetent,

etc., enter the name of the estate, and the name of the administrator or other fiduciary.

Part B

Item 2

Any person or organization qualifying as an employer on the basis of instructions contained in federal Circular E that maintains an

office or transacts business in New York State is an employer for NewYork State withholding tax purposes and must withhold from

compensation paid to its employees.

Item 3

Enter the first calendar quarter in which you paid (or expect to pay) total remuneration of $300 or more. Do not go back beyond 3

years from January of the current year. Remuneration includes compensation such as: salary, cash wages, commissions,

bonuses, payments to corporate officers for services rendered regardless of their stock ownership and without regard to how such

payments are treated under Sub-Chapter S of the IRS Code or any other tax law, reasonable money value of board, rent, housing,

lodging, or any similar advantage received, and the value of tips or other gratuities received from persons other than the employer.

Note: Do not include compensation paid to: daytime elementary or secondary students working after school or during vacation

periods; the spouse or child (under 21) of an individual owner; children under age 14; employees who perform no services in New

York State; or employees whose services are considered agricultural employment. If you have employees who work both within

and outside NY State, please request a ruling from the Liability and Determination Section of the Department of Labor. Phone

(518) 457-2635 for information.

Item 5

Answer Yes if there are persons working for you whom you do not consider to be your employees. Do not include those described

in Part B instructions for Item 3 which follow the Note. Attach a separate sheet if additional lines are required to accommodate

your explanation.

Item 6

Answer Yes if one or more of the following are true: you employed substantially the same employees as the pervious owner, you

continued or resumed the business of the previous owner at the same or another location; you assumed the previous owner's

obligations; and/or you acquired the previous owner's good will.

NYS-100 (10/02) (Page 3)

Form Nys 100 New York State Employer Registration Page 3

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