Form Es-802-0 - Election Of Employer'S Option To Become Liable For Payments In Lieu Of Contributions

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ES-802-0
(Rev. 7/04)
ELECTION OF EMPLOYER'S OPTION TO BECOME LIABLE
FOR PAYMENTS IN LIEU OF CONTRIBUTIONS
TO:
THE NEW MEXICO DEPARTMENT OF LABOR
Employment Security Division
P.O. Box 2281
Albuquerque, NM 87103
Pursuant to the provisions of Section 51-1-13 and Department Regulation 421 the
undersigned, an employing unit subject to the said Act, does hereby elect to make
payments in lieu of contributions beginning on
, and for
a period of not less than two consecutive calendar years, presents attached
hereto
a
completed
status
report
(ES-802)
showing
the
information
required
therein, a copy of the IRS exemption under Section 501 (c) (3) of the IRS Code,
Surety Bond or Cash Security Deposit, and hereby requests written approval by the
New Mexico Department of Labor of this election.
Enter Taxable wages paid during the prior 4 calendar quarters ending June 30.
If
no wages were paid during the preceding 4 calendar quarters ending June 30, then
show an estimate of Taxable wages to be paid.
1st Quarter
$
3rd Quarter
$
2nd Quarter
$
4th Quarter
$
(Legal Name of Employer)
By
Dated
Title
DECLARATION OF VERIFYING OFFICER:
The above officer whose signature appears on
this
document
is
a
duly
authorized
representative
of
the
employing
unit,
empowered to exercise the Option.
Dated
The above election commencing as of
,
is hereby [
]Approved
[
]Disapproved
NEW MEXICO DEPARTMENT OF LABOR
Acct. No.
By
Dated
Title
Submit in Triplicate
001-0866

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