Mail To:
Cashier - Texas Workforce Commission
P.O. Box 149037
Austin, TX 78714-9037
This form can be completed online at
www.texasworkforce.org
STATUS REPORT
This report is required of every employing unit, and will be used to determine liability under the Texas Unemployment Compensation Act.
If you have employment in Texas on a farm or ranch, please complete Form c-1fr, available online.
Identification Section
1. Account Number assigned by TWC (if any) |
2. Federal Employer ID Number |
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3. Type of ownership (check one) |
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corporation/pa/pc |
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limited partnership |
4. Name |
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partnership |
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estate |
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individual (sole proprietor/domestic) |
trust |
5. Mailing address |
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limited liability company |
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other (specify) |
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6. City |
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7. County |
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8. State |
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8(a). Zip code |
9. Phone Number |
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( |
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10. |
Business address where records or payrolls are kept: |
(if different from above) |
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Address |
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City |
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State |
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Zip |
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Phone Number ( ) |
11. |
Owner(s) or officer(s) [attach additional sheet if necessary] |
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Name |
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Social Security No. |
Title |
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Residence Address, City, State, Zip |
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12. |
Business locations in Texas [attach additional |
sheet if necessary] |
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Trade name |
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Street Address, City, Zip |
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Kind of business |
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No. of employees |
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13. |
If your business is a chartered legal |
entity, enter: |
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Charter number |
State of Charter |
Date of Charter |
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Registered agent's name |
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Registered agent's address |
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Original legal entity name, if name has changed |
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Employment section
14. |
Enter the date you first had employment in Texas (do not use future date): |
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Month |
Day |
Year |
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15. |
Enter the date you first paid wages to an employee in Texas (do not use future date): |
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16. |
If your account has been inactive: |
Enter the date you resumed employment in Texas: |
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Enter the date you resumed paying wages in Texas: |
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17. |
Enter the ending date of the first quarter you paid gross wages of $1,500.00 or more: |
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18. |
Enter the Saturday date of the 20th week that individuals were employed in Texas. |
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(All weeks should be in the same calendar year. Count a week if anyone performed any service for any portion of any day. |
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The services do not have to be performed on the same day of the week, in consecutive weeks or by the same employee. If |
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you do not reach 20 weeks of employment in the first calendar year of operation, begin again with the second calendar year |
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and count until you reach 20 weeks in that year.) Do not use future dates |
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19. |
If you hold an exemption from Federal Income Taxes under Internal Revenue Code Section 501(c)(3), attach a copy of your |
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Exemption Letter. Also, enter the ending date of the 20th week of the calendar year in which 4 or more persons were |
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employed in Texas: |
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20. |
Enter the year(s) your organization was liable for taxes under the Federal Unemployment Tax Act: |
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(begin with most recent year) |
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(year) |
(year) |
(year) |
(year) |
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21. Does this employer employ any U.S. citizens outside of the U.S.? |
Yes |
No |
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Domestic - Household Employment Section
Complete 22 only if you have domestic or household employees (includes maids, cooks, chauffeurs, gardeners, etc.)
22. Enter the ending date of the first calendar quarter in which you paid gross wages of $1,000 or more to employees |
Month |
Day |
Year |
performing domestic service: |
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Nature of Activity Section |
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23.Describe fully the nature of activity in Texas, and list the principal products or services in order of importance:
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
24.If the business in Texas was acquired from another legal entity, you must complete items 24-26. If a partial acquisition occurred, the predecessor/successor may jointly submit information regarding a partial transfer of experience.
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a) |
Previous owner’s TWC Account Number (if known) |
______________________________________________________________________________ |
b) |
Date of acquisition |
_________________________________________________________________________________________________________ |
c) |
Name of previous owner(s) |
_________________________________________________________________________________________________ |
d) |
Address |
________________________________________________________________________________________________________________ |
e) City |
_______________________ |
What portion of business was acquired? (check one)
State |
__________________________ |
Zip |
_________________________________ |
all |
part (specify) |
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25.On the date of the acquisition, was the previous owner(s), or any partner(s), officer(s), shareholder(s), other owner(s) or a person related by blood or marriage to any of these individuals, holding a legal or equitable interest in the predecessor business, also an owner, partner, officer, shareholder, or other owner of a legal or
equitable interest in the successor business? |
Yes |
No |
If “Yes”, check all that apply:
same owner, officer, partner, or shareholder
sole proprietor incorporating
other (describe below)
_________________________________________________
If “No,” on the date of the acquisition, did the previous owner(s), partner(s), officer(s), shareholder(s), other owner(s) or a person related by blood or marriage to any of these individuals, holding a legal or equitable interest in the predecessor business, hold an option to purchase such an interest in the successor business?
26.After the acquisition, did the predecessor continue to:
•Own or manage the organization that conducts the organization, trade or business?
•Own or manage the assets necessary to conduct the organization, trade or business?
•Control through security or lease arrangement the assets necessary to conduct the organization, trade or business?
•Direct the internal affairs or conduct of the organization, trade or business?
If “Yes” to any of above, describe: |
_____________________________________________________________________________________________ |
Voluntary Election Section
27.A non-liable employer may elect to pay state unemployment tax voluntarily. If an employer elects to do so, the employer is obliged to pay taxes for a minimum of two calendar years, beginning with January 1 of the first year of the election. The employer may withdraw the election by written request, at the end of the 2-year period, if not yet liable under the Texas Unemployment Compensation Act. To elect this option, complete the following:
Yes, effective Jan. 1, |
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I wish to cover all employees (except those performing service(s) which are specifically exempt in the Texas Unemployment |
Compensation Act). |
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Signature Section |
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I hereby certify that the preceding information is true and correct, and that I am authorized to execute this Status Report on behalf of the employing unit named herein. (this report must be signed by the owner, officer, partner or individual with a valid Written Authorization on file with the Texas Workforce Commission)
Date of signature:
Month ___ Day |
___ Year ___ |
Sign here ________________________________________ |
Title |
_______________ |
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Driver's license number |
__________________ State |
__________ E-mail address |
______________________________________________ |
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Individuals may receive, review and correct information that TWC collects about the individual by emailing to open.records@twc.state.tx.us or writing to: TWC Open
Records, 101 E. 15th St., Rm. 266, Austin, TX 78778-0001.
C-1BK (091415) |
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