UCT-17927-E, Reelection of Coverage of Principal Officers
Department of Workforce Development
Unemployment Insurance Division
Employer Service Team
P.O. Box 7942
Madison, WI 53707
Telephone: (608) 261-6700
Fax: (608) 267-1400
Email: taxnet@dwd.
REELECTION OF COVERAGE OF PRINCIPAL OFFICERS UNDER
WISCONSIN'S UNEMPLOYMENT INSURANCE ACT
Wisconsin State Statutes 108.025
To be effective for a calendar year, an employer shall file a notice of reelection no later than March 31 of that year. The corporation will receive an Initial Determination advising the status of this election.
The following named corporation:
|Business Name |WI UI Account Number |
| | |
Reelects, effective as of January 1, coverage under Wisconsin's Unemployment Insurance law all of its principal officers listed below, i.e. president, vice-president(s), secretary and treasurer.
|Principal Officer Name |% Ownership |Title in Corporation or LLC |SSN |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
The undersigned certifies that:
• They are a corporate officer with authority to act on behalf of the corporation.
• It is understood that an employer reelecting coverage of its principal officers is not eligible to again file an election to exclude principal officers under Wisconsin's Unemployment Insurance Act.
|Corporate Officer Name |Telephone Number |
| | |
|Corporate Officer Signature |Date Signed |
| | |
|Email Address |
| |
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REELECTION OF COVERAGE
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