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Form Nys 100 - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting Page 2

NYS 100 Page 2

Legal Name: __________________________________ER Number: _________________________

4. Are you registering for Unemployment Insurance?

Yes

• If yes, enter the first calendar quarter and the year you paid (or expect to pay) total remuneration of $300 or more. This

includes every form of compensation, including payments to employees or to corporate and Sub-Chapter S officers for

services.

Jan 1 – Mar 31 (1st)

Apr 1 – Jun 30 (2nd)

Jul 1 – Sep 30 (3rd)

Oct 1 – Dec 31 (4th)

Year

• If no, explain why you are not liable under the NYS Unemployment Insurance law.

________________________________________________________________________________________

5. Total number of covered employees:_____________________

6. Are you registering to remit withholding tax only?

Yes

7. Have you acquired the business of another employer liable for NYS Unemployment Insurance?

Yes*

*If Yes, did you acquire

All or

Part? Date of acquisition:

(mm/dd/yyyy)

Prior Owner’s Registration Number:

Prior Owners FEIN:

Legal Name of Business: ____________________________________________________________________

Address: _________________________________________________________________________________

8. Have you changed legal entity?

Yes*

*If yes, date of legal entity change:

(mm/dd/yyyy)

Prior Employer’s Registration Number:

Prior Employer’s FEIN:

Part C – Household Employer of Domestic Services

1. Indicate the first calendar quarter and enter the year you paid (or expect to pay) total cash wages of $500 or more:

Jan 1 – Mar 31 (1st)

Apr 1 – Jun 30 (2nd)

Jul 1 – Sep 30 (3rd)

Oct 1 – Dec 31 (4th)

Year

2. Enter the total number of persons employed in your home: ________________________

3. Will you withhold New York State income tax from these employees?

Yes

Part D – Required Addresses

* Refer to NYS – 100 I for instructions.

Form Nys 100 - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting Page 2

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