Form NYS-100, New York State Employer Registration for ...

1 Department of Taxation and Finance andDepartment of Labor-Unemployment Insurance Div Reg SecWA Harriman State Campus, Bldg 12 Albany NY 12240-0339 NYS-100(10/02)New york State Employer Registrationfor Unemployment Insurance,Withholding, and Wage ReportingFor office use only: Registration completed form (type or print in ink) to theaddress above, or fax to (518) Help? Call 1 888 899-8810 or (518) 457-4179 Part A - Employer Information1. Type (check one):2. Legal entity (check one - do not complete if household Employer ): Business (complete parts A, B, D, and E)Corporation (includes Sub-Chapter S)Limited liability company (LLC)Household Employer of DomesticServices (complete parts A, C, D, and E-1)Sole proprietorshipLimited liability partnership (LLP)Partnership*If nonprofit IRC 501 (C) (3), agricultural, orgovernmental Employer , do not complete thisform.

2 Phone (518) 485-8589 or write to theabove address to request the applicable (please describe)3. FEIN (Federal Identification Number)4. Telephone no. ( )5. Fax no. ( )6. Legal name7. Trade name (doing business as), if anyPart B - Business Employer (mmddyy)1. Enter date of first operations in New york State .. 2. Enter the date of the first payroll from which you withheld or will withhold NYS Income Tax from your employees' pay .. (mmddyy)3. Indicate the first calendar quarter and enter the year you paid (or expect to pay) total remuneration of $300 or more.

3 (Remuneration is every form of compensation, including payments to employees or to corporate and Sub-Chapter S officers for services) .. Jan 1 -Apr 1 -Jul 1 -Oct 1 -TaxMar 31 Jun 30 Sep 30 Dec 31 Year1 2 3 4Y Y4. Total number of employees5. Do persons work for you whom you do not consider employees? Yes No If Yes, explain the services performed andthe reason you do not consider these persons Have you acquired the business of another Employer liable for NYS Unemployment Insurance? Yes No.

4 If Yes, did you acquire All or Part? Date of acquisitionEnter previous owner information below:(mmddyy) Business name and addressEmployer Registration (mmddyy)7. Have you changed legal entity? Yes No. If Yes, enter the date of legal entity change .. Previous Employer Registration NumberPrevious FEINPart C - Household Employer of Domestic Services1. Indicate the first calendar quarter and enter the year you paid (or expect to pay) total cash wages of $500 or more ..Jan 1 -Apr 1 -Jul 1 -Oct 1 -TaxMar 31 Jun 30 Sep 30 Dec 31 Year1 2 3 4Y Y2.

5 Enter the total number of persons employed in your home3. Will you withhold New york State income tax from these employees? Yes NoNYS-100 (10/02)Part D - Address/Telephone InformationPlease enter your mailing and/or physical location address as well as the physical location of your books/records. If you wish to provide uswith additional addresses to direct specific forms, please indicate Mailing Address: This is YOUR business mailing address (NOTyour agent or paid preparer) where all your Unemployment Insurance/Withholding Tax mail will be directed unless otherwise indicated.

6 Street or PO BoxCity State ZIP Code*If all your Unemployment Insurance/Withholding Tax mail (includingForms NYS-45 and NYS-1) is to be received at this mailing address,do not complete sections 4 through City State ZIP Address: This is the ACTUAL location of your businessif different from the mailing address, or if your mailing address is Box. If you have more than one location, list your State ZIP Address: This is the physical location whereyour BOOKS/RECORDS can be found.

7 Same as no. 1 Same as no. 2 Other - please complete ADDITIONAL ADDRESSESc/oStreet or PO BoxCity State ZIP Address (c/o): This is the address of your AGENT, whereall your Unemployment Insurance mail will be directed unless otheraddresses have been provided for the mailing of specific forms insections 5 and/or 6. Note: All withholding tax mail (except quarterly return NYS-45 andReturn of Tax Withheld coupon NYS-1) must be sent to your mailingaddress (no.)

8 1). However, the quarterly return NYS-45 and couponNYS-1 may be directed to a separate address if no. 5 below is completed.( )c/oStreet or PO BoxCity State ZIP CodeQuarterly Combined Withholding, Wage Reporting andUnemployment Insurance Return (Form NYS-45) and Returnof Tax Withheld (Form NYS-1) Address: If completed, this is theaddress to which your NYS-45 and NYS-1 will be directed. 5. Same as no. 4 Other - please completec/oStreet or PO BoxCity State ZIP of Entitlement and Potential Charges Address: Ifcompleted, this is the address to which the Notice of Entitlementand Potential Charges will be mailed.

9 This form is mailed eachtime a former employee files a claim for Unemployment Insurancebenefits. Please attach a separate sheet if you need to indicatedifferent Notice of Entitlement and Potential Charges addresses formore than one physical E - Business InformationComplete the following for sole proprietor, household Employer of domestic services, all partners (including partners of LLP ), all members (of LLC or PLLC), and all corporate officers , whether or not remuneration is received or services are performed in NewYork Security Address(Continued on next page)NYS-100 (10/02) (Page 2)

10 Enter legal nameFor officeuse onlyPart E - Business Information (continued)2. For each of your establishments in New york State , answer A-E below. Use a separate sheet for each A. No. and StreetCity or TownCountyZIP how may persons do you employ there? the principal activity at the above tradeRetail tradeConstructionWarehousing TransportationComputer servicesEducational servicesHealth & social assistanceReal estateScientific/professional & technical servicesFinance and insuranceArts, entertainment, & recreationFood service, drinking, & accommodationsCorporate, subsidiary managing officeOther (Please specify) you are primarily engaged in manufacturing, complete the following.