Status Report Form - Texas Workforce Commission
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1
2MAIL TO:
Texas Workforce Commission
P.O. Box 149080
Austin, Texas 78714-9080
Status Report
Farm and Ranch Employment
(You should retain one copy for your files)
Identification Section
TYPE OF OWNERSHIP (CHECK ONE)
1.
ACCOUNT NUMBER ASSIGNED BY TWC (IF ANY)
2.
FEDERAL EMPLOYER ID NUMBER
3.
CORPORATION (01)
OTHER (06)
PARTNERSHIP (02)
LIMITED LIABILITY COMPANY (07)
4.
NAME
SOLE PROPRIETOR (03)
LIMITED PARTNERSHIP (02)
ESTATE (04)
LIMITED LIABILITY
5.
MAILING ADDRESS
TRUST (05)
PARTNERSHIP (02)
6.
CITY
7.
COUNTY
8. STATE
8(a). ZIP CODE
9
PHONE NUMBER
(
)
10.
ADDRESS
PHONE NUMBER
Business address where records or payrolls
(
)
are kept (if different from above):
CITY
STATE
ZIP
11.
NAME
S S NO.
TITLE
RESIDENCE ADDRESS, CITY, STATE, ZIP
OWNER
OR
OFFICERS
ATTACH
ADDITIONAL
SHEET IF
NECESSARY
12.
TRADE NAME
STREET ADDRESS, CITY, COUNTY
NUMBER OF
BUSINESS
EMPLOYEES
LOCATION IN
TEXAS
ATTACH
ADDITIONAL
SHEET IF
NECESSARY
13.
CHARTER NUMBER
STATE INCORPORATED
DATE INCORPORATED
REGISTERED AGENT'S NAME
If your business
is a corporation,
enter:
ORIGINAL CORPORATE NAME, IF DIFFERENT FROM ABOVE
ADDRESS (CITY, STATE, ZIP)
Farm & Ranch Employment Section
Enter the date on which your organization first employed someone to perform farm and
MO.
DAY
YEAR
14.
ranch labor in Texas.
Enter the date on which your organization first paid wages to someone performing farm
15.
and ranch labor in Texas.
Enter the ending date of the 20th week in which you had at least three persons
16.
employed in Texas performing farm or ranch labor.
Enter the ending date of the first calendar quarter during the calendar year in which you
17.
paid total gross wages of $6,250 or more for farm and ranch labor. (Include wages of
seasonal, migrant and any other farm and ranch labor.)
Enter the date on which your organization first employed migrant workers in Texas.
18.
Enter the date on which your organization first employed seasonal workers in Texas to
19.
perform work on a truck farm, orchard or vineyard.
YES
YES
YES
Are you a crew leader?
20.
If yes, do you hold a valid
If no, do substantially all
NO
NO
NO
(Check one)
certificate of registration
of the members of the
under the Farm Labor
crew operate equipment
Contractor Act? (Check one)
which you provide?
(Check one)
Enter the year(s) your organization was liable for taxes
19.
under the Federal Unemployment Tax Act. (Begin with
the most recent year.)
(Continued on reverse side)
C-1FR (0499) Inv. 518175
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