Form Ibr-1 - Unemployment Insurance Status Report / State Tax Commission / Industrial Commission- Idaho Department Of Labor Page 2
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1
2
3
4Revised
TC00072
1997
4-30-97
Yes
No
2 9 . Did you purchase or lease all or part of a previous employer's business?
Previous owner's name
SUTA account no.
Acquired
Day
Year
Month
What portion of the previous business did you acquire? Please check one. _____All _____Part
Experience rating record transfer: An experience rating record transfer may be allowed upon the joint application of the successor and the
predecessor. This may allow a reduced rate. Information will be sent if you are a successor of a previous employer. Check here
if you
want the experience rating record of your predecessor. If the agency finds completion of a transfer form unnecessary, your signature on this
form authorizes the transfer.
PLEASE COMPLETE APPROPRIATE SECTION BELOW:
REGULAR
3 0 . Enter the date you paid or expect to pay total Idaho wages of $1500 or more in this *calendar quarter in this or any of the three preced-
ing years.__________________________________________
During how many weeks did you have one or more persons employed during some portion of a day in Idaho?
In this calendar year____________ In the last calendar year ____________ In the year before last ____________
*Calendar Quarters Defined
1st Quarter = January - March
2nd Quarter = April - June
3rd Quarter = July - September
4th Quarter = October - December
AGRICULTURAL
3 1 . Enter the date you paid or expect to pay total Idaho cash wages of $20,000 or more in this or any calendar quarter in any of the three
preceding years.____________________________________________
During how many weeks did you have ten or more persons employed during some portion of a day in Idaho?
In this calendar year____________ In the last calendar year ____________ In the year before last ____________
DOMESTIC -- HOUSEHOLD EMPLOYMENT SECTION
3 2 . Enter the date you paid or expect to pay total Idaho cash wages of $1,000 or more to employees performing DOMESTIC SERVICE in this
or any calendar quarter in this or any of the three preceding years.___________________________________________
* * * * IMPORTANT: Complete all areas below. * * * *
3 3 . List amount paid or estimate wages in Idaho beginning with month of first employment (even though such wages may already have been
reported). If no wages are paid during some of the months, write "NONE." If you do not have employees yet, estimate the wages to the best
of your ability.
Month of the Year
$
$
$
$
$
$
Amount
Yes
3 4 . Were you subject to the Federal Unemployment Tax Act during the current or preceding year? ....................................
No
3 5 . Is this a nonprofit organization exempt from tax under Internal Revenue Service Code 501(c)(3)? ................................
Yes
No
Yes
3 6 . If yes, do you want additional information regarding the cost reimbursement option of financing benefit costs? .........
No
PUBLICATION CONSENT
3 7 . Please check:
Yes, my company wants to be included in the Business Directory of Idaho, published by the Department of Commerce, knowing the full
extent of the data published will be: business name, address, phone number, SIC code, range of employees, major occupations, and informa-
tion that will be included in county/industry totals. A signature is required for this endorsement.
Print or type name
Title
Date
Authorized signature
The following is a sample listing from the Business Directory of Idaho.
SIC Code:
6311 LIFE INSURANCE
Company Name:
Gem Life and Accident
Company Address:
1234 Empire Way
Pocatello, ID 83210
Company Phone:
(208)294-5284
Range of Employees:
Number of Employees - **B
Major Occupations:
43002 Sales Workers
15008 Health Service Manager
**(Range of Employees: 1-4=A, 5-9=B, 10-24=C, 25-49=D....1000+=I)
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