Free 46798.pdf - Indiana

STATUS REPORT AGRICULTURAL EMPLOYMENT
State Form 46798 (R3 / 7-05) INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT 10 N SENATE AVE RM SE106 INDIANAPOLIS IN 46204-2277 Local: 317-232-7436 Toll Free: 1-800-891-6499 Fax: 317-233-2706

Original Report Amended Preassigned

CONFIDENTIAL RECORD Pursuant to IC 22-4-19-6, IC 4-1-6

OFFICE USE ONLY
Account Number Effective Date

Please type or print in ink.

1. Legal Name of Employing Unit
Qualified On Under Section

2. Street Address

Pymt. Method

Merit Rate Start Date

Business Type

Merit Year Rate % % % % % %

City

State
Country Code

ZIP Code

Indiana County

County Code

__ __ __ __ __ - __ __ __ __ - __ __ - __
Reviewed By

3. Federal ID Number: __ Individual Other (specify)

__ - __ __ __ __ __ __ __
Corporation Trust Partnership Guardian Administrator Other Fiduciary

4. On what date did you first employ individual(s) in the State of Indiana? 5. Did you pay $20,000 or more in wages to individuals employed in agricultural labor during any calender quarter in either the current or a preceding calendar year? Yes(Quarter/Year) / 6. Name Title Social Security Number Residence Telephone Number Name Title Social Security Number Residence Telephone Number Yes No

7. Are you an employer under Indiana Law for employees other than agricultural? (if yes, enter Indiana Unemployment account number) ___ ___ ___ ___ ___ ___

8. Did you employ 10 or more individuals in agricultural labor for some portion of a day (not necessarily at the same time of the day) in each of 20 different calendar weeks, whether or not such weeks were consecutive, during either the current or preceding calendar year? Yes No I hereby certify that I have carefully examined the foregoing questions and that my answers thereto and all information contained herein are true and complete to the best of my knowledge and belief.

Prepared By

Title

Date

(

)

Preparer / Accountant Phone Number

Employer Signature

Date

(See back of page for additional information)

Agricultural Labor includes: 1)Employing individuals on a farm, who cultivate soil, or in connection with cultivating of the soil, or in connection with the raising or harvesting of any agricultural or horticultural commodity. This includes the raising, shearing, feeding, caring for, training, and the management of livestock, bees, poulltry, and furbearing animals and wildlife.

2)Farm includes stock, dairy, poultry, fruit, furbearing animals, truck farms, nurseries, orchards, greenhouses, or other similar structures used primarily for the raising of agricultural and horticultural commodities. 3)Services performed in connection with maintaining the operation of a farm.

4)Services performed in connection with production or harvesting of any commodity in Section 15(g) [12 U.S.C. ...1141j (g)] of the Agricultural Marketing Act, as amended or in connection with the operation or maintenance of ditches, canals, reservoirs, and waterways, not owned or operated for a profit, used only for supply and storing water for farming purposes.

5)On a farm operated for profit if such service is not in the course of the employers trade or business or is domestic service in a private home of the employer.

6) A seperate quarterly report (UC1 + UC5) must be filed for each quarter of wages.

For further details, see IC 22-4-8-3(c) and IC 22-4-8-2(I). If you have any questions, please call (317) 232-7436