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Business License Audit & Gap Analysis Report 02/25/2010

Attached are the results of the Audit & Gap Research conducted on your behalf. Results provided below are by location.

Audit & Gap Analysis Report: ABC TRUCK LEASING, INC.,Smyrna,TNResearch based on the business activity provided to CSC: Truck Leasing/rental, used truck sales, repair services.

Entity Name: ABC TRUCK LEASING, INC.Contact Name: MICHAEL FLOYDContact Email: [email protected] Phone: 555-626-5222Location Street Address: 250 Expr DriveLocation City, State and Zip: Smyrna,TN,37169Location County: RutherfordList of Licensing Authorities Contacted:

- State of Tennessee, Motor Vehicle Commission

- Rutherford County Clerk

- Town of Smyrna Treasurer

- State of Tennessee, Department of State

- State of Tennessee, Department of Revenue

- State of Tennesee, Department of Labor and Workforce Development

Status of Existing Licenses Based on the list you provided to CSC, we have researched each of your existing licenses and provided detailed status information in the chart below.

Type of License License # Issuing Authority Juris. Type Status Renewals Exp. Date NotesMotor VehicleDealer License

02214518 State ofTennessee, MotorVehicleCommission

State Active 10/31/2011

Additional Licensing Requirements CSC has identified additional licensing requirements that your business must satisfy to remain in compliance. Please see the chart below.

Type of License License # Juris. Type Attachment NotesBusiness TaxLicense

County This license mustbe filed in personat the CountyClerk's Office.Fee is $15.

Business TaxLicense

Municipality Application forBusiness TaxLicense

Registration ofAssumedCorporate Name

State Application ForRegistration ofAssumedCorporate Name

Business TaxRegistration

State Business TaxRegistrationApplication

Employer StatusReport

State Report ToDetermine StatusApplication ForEmployer Number

CSC does not guaranty that this package contains information regarding all authorizations, licences or permits necessary to operate your business. We do not draw legal conclusions, provide legal advice or apply the

law to the facts of your particular situation. No representations or warranties, expressed or implied, are given regarding the legal or other consequences resulting from the use of our services, reports or forms.

Samp

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Licenses May Not Be Required CSC has identified licenses that are not required for your business. Eliminating these licenses can help your organization reduce its costs.

Business License Audit & Gap Analysis Report

If you have questions regarding this application, pleasecontact the issuing authority using the informationprovided below.

Issuing Office

Mailing AddressMail the application to the mailing address providedbelow, unless otherwise noted on the form.

General Notes

Information pertaining to this form

Application for Business TaxLicense

Sample

HUSBAND/WIFE OWNERSHIP

APPLICATION FOR BUSINESS TAX LICENSE

ALL QUESTIONS MUST BE ANSWERED COMPLETELY. INCOMPLETE AND UNSIGNED APPLICATIONS WILL DELAY PROCESSING.FOR ASSISTANCE, PLEASE CONTACT YOUR LOCAL COUNTY CLERK OR DESIGNATED CITY OFFICIAL.

1. INDICATE THE CLASSIFICATION IN WHICH YOU ARE REGISTERING. CLASSIFICATION IS DETERMINED BY THE DOMINANT BUSINESS ACTIVITY. INDICATE ONLY ONE CLASSIFICATION.

2. REASON FOR APPLYING:

1. New business 3. Purchase of existing business2. Additional location

3. DATE BUSINESS BEGAN IN TENNESSEE ATTHIS LOCATION:

4. BUSINESS NAME AND EXACT LOCATIONBUSINESS NAME

STREET OR HIGHWAY (DO NOT USE P.O. BOX NUMBER OR RURAL ROUTE NUMBER)

CITY STATE ZIP CODE

5. BUSINESS MAILING ADDRESSNAME (ENTER LEGAL NAME, IF DIFFERENT)

P.O. BOX, STREET, ROUTE, OR HIGHWAY

CITY STATE ZIP CODE

6.

IS BUSINESS LOCATED INSIDE A TENNESSEE CITY?YES

7. BUSINESS TELEPHONE NUMBER

( )

ENTER FEDERAL EMPLOYER'S IDENTIFICATION #9. APPLIED FORNOT REQUIRED

11. TYPE OF OWNERSHIP (SELECT ONE):

PROPRIETORSHIP

CORPORATION

TENNESSEE SECRETARY OF STATEIDENTIFICATION #, IF APPLICABLE

12.

13. DESCRIBE THE BUSINESS ACTIVITY AT THIS LOCATION, STATING THE MAJOR PRODUCTS AND/OR SERVICES SOLD:

PARTNERSHIP

OTHER

RV-F1321001

15. THE STATEMENTS MADE ON THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. (THIS APPLICATION MUST BE SIGNED BYTHE INDIVIDUAL OWNER, A PARTNER, OR AN OFFICER OF THE CORPORATION. THE SIGNATORY MUST ALSO BE LISTED IN ITEM 14.)

SIGNHERE:

SIGNATURE of OWNER, PARTNER, or OFFICER (DO NOT PRINT OR USE STAMP)

Classification 1A

Classification 1B

Classification 1C

Classification 1D

Classification 2

Classification 3

Classification 4

Classification 5

( )

BUSINESS FAX NUMBER

INTERNET (10-09)

14. IDENTIFY OFFICERS, PARTNERS, OR INDIVIDUAL OR COMPANY OWNERS

8. CONTACT PERSON’S NAME

NO

COUNTY IN WHICH BUSINESS IS LOCATED

CONTACT E-MAIL ADDRESS

(If Yes, Name of City)

CURRENT SALES TAX NUMBER FOR THIS BUSINESS LOCATION10. APPLIED FORNOT REQUIRED

TITLE DATE

LIMITED LIABILITY COMPANY

(1) NAME

HOME ADDRESS (DO NOT USE P.O. BOX #) CITY

HOME TELEPHONE # SOCIAL SECURITY #

STATE ZIP CODE

(2) NAME


HOME TELEPHONE # SOCIAL SECURITY #

STATE ZIP CODE

Member Owner - IndividualOfficer Partner

Member Officer Partner

Owner - Company

Owner - Individual Owner - Company

FEDERAL EIN

FEDERAL EIN

APARTMENT OR SUITE NUMBER (DO NOT ENTER P.O. BOX OR RURAL ROUTE NUMBER) APARTMENT OR SUITE NUMBER

Sample

INTERNET (10-09)

APPLICATION FOR BUSINESS TAX LICENSE INSTRUCTIONS

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Select the classification under which your dominant business activity falls. “Dominant business activity” means the businessactivity that is the major and principal source of taxable gross sales of the business. If you need assistance in determining theappropriate business tax classification, please ask your county clerk or the designated city business tax official. You may also wishto refer to the document “Determining Your Business Tax Classification,” which is available at tn.gov/revenue.

Select the reason for which the application is being filed - new business, additional location, or the purchase of an existing business.

Enter the date on which the applicant began or will begin conducting business activities at the location for which registration isbeing made.

Enter the name and exact location address of the business being registered. Include the business name, street address, city, state,and zip code.

Enter the mailing address of the business being registered. Enter the legal name (if different from location name), street addressor post office box number, city, state, and zip code. If the legal name and mailing address are identical to the informationin Item 4, leave Item 5 blank.

Enter the name of the county in which the business is located. Indicate whether the business is located within the limits of a city inthe county. If the business is located within the limits of a city, enter the name of the city. Note: A business located within thelimits of a city may have a business tax obligation for both the county and the city. If so, the business must obtain abusiness license from both the county and the city.

Enter the telephone number and, if applicable, the fax number of the business being registered.

Enter the name of a contact person for the business being registered. Enter the contact person’s email address.

Enter the Federal Employer’s Identification Number (FEIN) of the business being registered. If the business has applied for butnot received an FEIN, so indicate. If no FEIN is required, so indicate.

If the business being registered currently has a sales and use tax account with the Tennessee Department of Revenue, enter thesales and use tax account number. If the business has applied for but not received a sales and use tax account number, so indicate.If no sales or use tax account number is required, so indicate.

Select the legal structure type of the business being registered.

Enter the Tennessee Secretary of State identification number of the business being registered, if applicable.

Enter a description of the business activities being performed by the business at the location being registered. Indicate the mainproducts and services sold at this business location. Please be as detailed as possible.

Enter the names, home addresses, and home telephone numbers of two owners, officers, or partners in the business beingregistered. If the owner is an individual, enter the owner’s social security number and check the appropriate box. If the owner isa business entity, enter the owner’s FEIN and check the appropriate box. Finally, check the box to indicate whether the person isan individual or business entity owner, partner, officer, or member. This information is critical. It will allow us to identify personswith whom we may discuss the business tax account when needed.

The application must be signed by an individual owner, partner, or officer of the business being registered. The person who signsthe application must be listed in Item 14 on the application form. Indicate the title of the person signing the application (i.e., owner,partner, officer) and the date on which the application is signed.

Sample



Issuing Office


General Notes


Application For Registration ofAssumed Corporate Name

Sample

APPLICATION FORREGISTRATION OF

ASSUMED CORPORATENAME

SS-4402 (Rev. 4/01) Filing Fee: $20 RDA1720

Corporate Filings312 Eighth Avenue North

6th Floor, William R. Snodgrass TowerNashville, TN 37243

For Office Use Only

Pursuant to the provisions of Section 48-14-101(d) of the Tennessee Business Corporation Act or Section 48-54-101(d) ofthe Tennessee Nonprofit Corporation Act, the undersigned corporation hereby submits this application:

1. The true name of the corporation is

2. The state or country of incorporation is

3. The corporation intends to transact business in Tennessee under an assumed corporate name.

4. The assumed corporate name the corporation proposes to use is

[NOTE: The assumed corporate name must meet the requirements of Section 48-14-101 of the Tennessee BusinessCorporation Act or Section 48-54-101 of the Tennessee Nonprofit Corporation Act.]

Signature Date Name of Corporation

Signer's Capacity Signature

Name (typed or printed)

.

.

.

Sample



Issuing Office


General Notes


Business Tax RegistrationApplication

Sample

HUSBAND/WIFE OWNERSHIP

____ FRANCHISE AND EXCISE TAXES

WILL YOU BE COLLECTING OVER$200 PER MONTH IN SALES TAX?

**The local county clerk and designated municipal business tax official in your area also have business tax registration forms.

APPLICATION FOR REGISTRATION

ANSWER ALL QUESTIONS COMPLETELY. INCOMPLETE AND UNSIGNED APPLICATIONS WILL DELAY PROCESSING. FOR ASSISTANCE YOU MAYCONTACT ANY OF THE T AXPAYER AND VEHICLE SER VICES OFFICES LISTED ON THE BACK.1. CHECK ANY OF THE FOLLOWING TAX, PERMIT, OR FEE REQUIREMENTS FOR WHICH YOUR BUSINESS IS LIABLE:

*ALCOHOLIC BEVERAGE TAXES:

____ Brand Registration____ Liquor By The Drink____ Wholesale Beer____ Wholesale Gallonage GROSS RECEIPTS TAXES:

____ Bottlers____ Mixing Bar____ Gas, Water, Electric Power

& Light

____ *PETROLEUM TAXES

____ Auto Rental Surcharge____ Bail Bondsmen____ Litigation Tax____ Professional Privilege Tax

____ SALES AND USE TAX

SEVERANCE TAXES:____ Coal____ Crude Oil/Natural Gas____ Mineral

SOLID WASTE TAXES:____ Tire____ Used Oil

____ TOBACCO TAX

*Requires Bond. TYPE OF BOND: 1. SURETY 2. CASH 3. CERTIFICATE OF DEPOSIT

2. REASON FOR APPLYING:1. New business

3. Purchase of existing business2. Additional location

WILL YOUR GROSS SALES EXCEED $4,800 PER YEAR?WILL YOUR TAXABLE SERVICES EXCEED $1,200 PER YEAR?DO YOU HAVE SUPPLIERS (IN-STATE OR OUT-OF-STATE) WHO DO NOT COLLECT TN. SALES TAX?IF ALL THREE OF THE ABOVE ARE "NO", YOU DO NOT NEED A SALES TAX #.

3. YES NOYES NOYES NO

4a. DATE BUSINESS BEGAN IN TENNESSEE AT THIS LOCATION

5.

YES NO

6. HOW MANY MONTHS OF THE YEAR WILL YOUHAVE SALES AND/OR USE TAX TO REPORT?

7. BUSINESS NAME AND EXACT LOCATIONBUSINESS NAME (ATTACH LIST IF NECESSARY FOR ADDITIONAL LOCATIONS)

STREET, HIGHWAY (DO NOT USE P.O. BOX NUMBER OR RURAL ROUTE NUMBER)

CITY STATE ZIP CODE COUNTY

8. BUSINESS MAILING ADDRESSNAME (ENTER CORPORATION NAME, IF APPLICABLE)

P.O. BOX, STREET, ROUTE, OR HIGHWAY

CITY STATE ZIP CODE

9. IS THIS BUSINESS LOCATED INSIDE ANY TENNESSEECITY LIMITS? YES NO

IF YES, WHAT CITY?

10. RECORD STORAGE ADDRESS:STREET, HIGHWAY (DO NOT USE P.O. BOX NUMBER)

CITY STATE ZIP CODE

11. BUSINESS TELEPHONE #

( )

AREA CODE

FAX #

ENTER YOUR FEDERAL EMPLOYER'S IDENTIFICATION #12. APPLIED FORNOT REQUIRED

14. TYPE OF OWNERSHIP:PROPRIETORSHIP

CORPORATION

CURRENT OR PRIOR TAX NUMBER15.(SALES TAX, ETC.)

TAX TYPE

16. DESCRIBE THE BUSINESS ACTIVITY AT THIS LOCATION, STATING THE MAJOR PRODUCTS AND/OR SERVICES SOLD.

PARTNERSHIP LIMITED PARTNERSHIP

LIMITED LIABILITY COMPANY PROFESSIONAL LIMITED LIABILITY COMPANY

OTHERPROFESSIONAL CORPORATION

NAME OF CORPORATION SEC. OF STATE #

ACCOUNT NO./

4b. FISCAL YR. END /MO DAY

S CORPORATION

RV-F1300501

____ WINE DIRECT SHIPPER

INTERNET (1-10)

PRIVILEGE TAXES:

13a. BUSINESS CONTACT PERSON: E-MAIL ADDRESS:13b.

TENNESSEE DEPARTMENT OF REVENUE

TAXES

**BUSINESS TAX

____ Classification 1____ Classification 2

____ Classification 3 ____ Classification 4 ____ Classification 5

(Note: If you ever have a sale for which you ship or deliver merchandise, do not check “Yes.”)A. Are your sales 100% over-the-counter sales? ______ Yes ______ No

B. If not 100% over-the-counter sales, how many cities or counties in Tennessee, other than the location of your business do you ship or delivermerchandise to in an average month? _______________________

Beer Barrelage

Winery Tax

Sample

IDENTIFY OWNERS, OFFICERS, MEMBERS, OR PARTNERS (ATTACH ADDITIONAL NAMES ON SEPARATE SHEET).

(1) NAME


HOME TELEPHONE #

STATE ZIP CODE

(2) NAME


HOME TELEPHONE #

STATE ZIP CODE

STATE ZIP CODE

(3) NAME


HOME TELEPHONE #

PREVIOUS BUSINESS NAME PREVIOUS OWNER'S TELEPHONE #( )

STILL IN BUSINESS?YES NO

PREVIOUS OWNER'S NAME AND ADDRESS

20.

IF YOU ARE AN OUT-OF-STATE BUSINESS THAT WILL BE DOING BUSINESS IN TENNESSEE, PLEASE ANSWER THE FOLLOWING QUESTION.

DO YOU HAVE A LOCATION OR OFFICE IN TENNESSEE? YES NO IF YES, NAME LOCATION:

THE STATEMENTS MADE ON THIS APPLICATION ARE TRUE TO THEBEST OF MY KNOWLEDGE AND BELIEF. (THIS APPLICATION MUSTBE SIGNED BY THE INDIVIDUAL OWNER, A PARTNER, OR AN OFFICEROF THE CORPORATION LISTED IN ITEM 17.)

SIGNHERE:

OWNER, PARTNER, OR OFFICER (DO NOT PRINT OR USE STAMP)

FOR DEPARTMENT USE ONLY

EDI/EFT DO YOU CURRENTLY FILE YOUR RETURN BY EDI? YES NO DO YOU CURRENTLY REMIT PAYMENT BY EFT? YES NO

WOULD YOU LIKE TO RECEIVE INFORMATION ABOUT THE FOLLOWING: EDI EFT

For additional information, contact the Taxpayer and Vehicle Services Division in one of our Department of Revenue Offices:

Tennessee residents can also call our statewide toll free number at 1-800-342-1003. Out-of-state callers must dial (615) 253-0600.

Johnson City(423) 854-5321204 High Point DrivePO Box 2365Johnson City, TN 37605-2365

Chattanooga(423) 634-6266Suite 350State Office Building540 McCallie AvenueChattanooga, TN 37402

Memphis(901) 213-14003150 Appling RoadBartlett, TN 38133

Nashville(615) 253-06003rd FloorAndrew Jackson Building500 Deaderick StreetNashville, TN 37242

Jackson(731) 423-5747Suite 340Lowell Thomas Building225 Martin Luther King Blvd.Jackson, TN 38301

Knoxville(865) 594-6100Room 606State Office Building531 Henley StreetKnoxville, TN 37901

INTERNET (1-10)

17.

18.SOCIAL SECURITY # FEDERAL EIN

Member Owner - IndividualOfficer Partner Owner - Company

SOCIAL SECURITY # FEDERAL EIN


19.


SOCIAL SECURITY # FEDERAL EIN

C. Do you use/have access to: (a) Automated systems _____ Yes (b) Computers _____ Yes (c) Internet _____ Yes?

D. Do you lease tangible personal property in one location for use in another? _____ Yes _____ No

E. Do you lease space in a business location to another company? ______ Yes _____ No

F. Do you sell at retail? ______ Yes _______ No Wholesale? _____ Yes _____ No Both? _____ Yes _____ No

G. If you are a contractor, do you perform contracts in the city or county where your business is located? _____ Yes _____ No

H. If you are a contractor, do you perform contracts in a city or county where your business is not located? _____ Yes _____ No

I. If you are a contractor, do you install everything you sell? _____ Yes _____ No

Sample



Issuing Office


General Notes


Report To Determine StatusApplication For Employer Number

Sample

TENNESSEE DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT

REPORT TO DETERMINE STATUSAPPLICATION FOR EMPLOYER NUMBER

1.Enter Federal Number, Business Name and Address

Federal Number ___ ___ - ___ ___ ___ ___ ___ ___ ___

Employer Name _______________________________________

_______________________________________

Trade Name _______________________________________

_______________________________________

Mailing Address _______________________________________

_______________________________________

_______________________________________

3.CHECK (X) FORM OF ORGANIZATION

INDIVIDUAL

PARTNERSHIP

CORPORATION

LIMITED LIABILITY COMPANY

LIMITED PARTNERSHIP

OTHER

NOTE: If a Limited Liabilty Company, are you treated by IRS as a(n) Individual Proprietorship Partnership or as a Corporation

4. Name of Owner, Partners, Corporate OfficersLimited Liability Company Members and Managers(If Board Managed), General Partners(Attach separate sheet if necessary)

7. REGULAR BUSINESS EMPLOYMENT (SEPARATE REPORTS MUST BE FILED FOR EACH CALENDAR QUARTER IN WHICH WAGES WERE PAID)

A. Have you employed or do you expect to employ at least one worker in twenty different calendar weeks during a calendar year? YES NO

If Yes, give earliest month and year the twentieth week occurred (will occur). MONTH ______________________ YEAR _______________

B. Have you had or do you expect to have a quarterly payroll of $1,500 or more? YES NO

If Yes, give earliest quarter and year this occurred (will occur). QUARTER ______________________ YEAR ____________________

8. HOUSEHOLD EMPLOYMENT (SEPARATE REPORTS MUST BE FILED FOR EACH CALENDAR QUARTER IN WHICH WAGES WERE PAID)

A. Have you had or do you expect to have a $1,000 quarterly payroll for domestic services? YES NO

If Yes, give earliest quarter and year this occurred (will occur). QUARTER ______________________ YEAR _______________

9. AGRICULTURAL EMPLOYMENT (SEPARATE REPORTS MUST BE FILED FOR EACH CALENDAR QUARTER IN WHICH WAGES WERE PAID)

A. Have you employed or do you expect to employ at least ten or more workers in some part of a day in twenty different weeks during a calendar year?

YES NO If Yes, give earliest month and year this occurred (will occur). MONTH ______________________ YEAR ______________

B. Have you had or do you expect to have a quarterly payroll of $20,000 or more? YES NO

If Yes, give earliest quarter and year this occurred (will occur). QUARTER ______________________ YEAR _______________

If you answer Yes to any one of the questions 6D, 7, 8, 9, or 10F, you are liable for unemployment insurance premiums based on the first $7,000 paideach employee per year.Have you previously had an account with this department? YES NO Account Number ____________________________

Signature ____________________________________ Title _________________________ Date ________________________Must be owner, partner, authorized limited liability company member or manager, or officer of the corporation.

PLEASE COMPLETE PAGE 2. FAILURE TO DO SO WILL RESULT IN RECEIVING THE HIGHEST PREMIUM RATE ASSIGNABLE.

Social Security Number Residential Address and Phone

5. Name of person responsible for payroll records _____________________________________ Phone Number _______________________

LB-0441 (Rev 8/07)

6. A. Number of workers you have employed (will employ) in TN __________________ D. Are you presently reporting for U.I. purposes in another state?

YES NO If Yes, which state? ___________________

E. If a corporation or LLC, provide formation information.

Date _______________ State ____

RDA N/A

2. Is your organization a Staff Leasing Company? YES NO If Yes, Tennessee license number __________________

Is your organization a client of a Staff Leasing Company? YES NO

PHYSICAL BUSINESS ADDRESS in Tennessee if different from above:

_______________________________________________________

_______________________________________________________

B. Date you first employed (will employ) a worker in TN _______________________

C. Date you first paid (will pay) a worker in Tennessee _______________________

/ // / / /

/ /

ID No. _______________

RETURN TO: EMPLOYER SERVICESTN DEPT OF LABOR AND WORKFORCE DEVELOPMENT220 FRENCH LANDING DRIVENASHVILLE TN 37243(615) 741-2486 FAX (615) 741-7214 OFFICIAL USE ONLY

Tennessee ID# M. No. County AreaSIC

Rate

M-SICComp Year NAICS

Liab. Org.

Previous No. ROC AUX-SIC VERIFIED

M-NAICS

Date LiableFirst Employment

FAX: ( _______ ) ______________________

( _______ ) ___________________PHONE:

E-MAIL ADDRESS: _____________________________

Sample

10. (A) Name and Address of predecessor employer _____________________________________________________________________________________________________________________________________________________________________

(B) Account Number of predecessor employer _____________________ (C) Date of acquisition _____/_____/_____

(D) Did you acquire all of your predecessor’s business in Tennessee? YES NO If No, what percentage did you acquire? _____

(E) Did your predecessor continue in business in Tennessee? YES NO

(F) Tennessee Employment Security Law provides for the mandatory transfer of an employer’s benefit and premium experience whenever there isany common ownership, management or control between the predecessor and successor employers.

Did any owner or manager of this company have an ownership interest in or participate in the management or control of thebusiness acquired? YES NO

If “YES,” please explain: __________________________________________________________________________________

Per TCA 50-7-403(b)(2)(C)(ii) “Common ownership, management or control” includes any individual who has at least a 10% ownership interestin - or who participates in the management or control of - the predecessor’s trade or business and has a relative with a 10% ownership interest in -or who participates in the management or control of - the successor’s trade or business.

Does anyone who had a 10% or more ownership interest in the previous company - or who participated in its management orcontrol - have a relative with a 10% or more interest in this company or who participates in its management or control?

YES NO If “YES,” please explain: __________________________________________________________________

If you are not subject to a mandatory transfer of experience but wish to succeed to the experience of the predecessor employer, Form LB-0483,Application for Transfer of Experience Rating Record, must be submitted by no later than the end of the quarter following the quarter in whichthe acquisition occurred.

11. Enter below the amount of total payroll for each quarter in which you have had or expect to have employment.

For the work location covered by this application, is the main activity to: (Check one)Supply products and services to the general public or other companies

Support other locations of your company (if you check this, please specify below)

HEADQUARTERS (e.g. : Corporate or regional management offices)

ADMINISTRATIVE, OTHER THAN HEADQUARTERS (e.g.: data processing, public relations)

RESEARCH (e.g.: R & D, product testing, laboratory)

STORAGE (e.g.: warehouse, distribution center, equipment yard)

OTHER (please describe) (e.g.: Repair shop, security office, maintenance, employee recreation facility)

Please check the box describing your company’s major business activity:Agriculture, Forestry, Fishing and Hunting

Mining

Utilities

Construction

Manufacturing

Wholesale Trade

Retail Trade

Transportation and Warehousing

Information

Finance and Insurance

Real Estate and Rental and LeasingProfessional, Scientific, Technical Services

Management of Companies and Enterprises

Administrative and Support and Waste Management

and Remediation Services

Educational Services

Health Care and Social Assistance

Arts, Entertainment and Recreation

Accommodation and Food Services

Other Services (except Public Administration)

Public Administration

In what Tennessee County is your company located? ________________________________________________________

(If account covers sales reps or other personnel working from home, list county of residence. If county is unknown, list city of residence.)

LB-0441 (Rev. 8/07)

NOTE: If your organization is exempt from Federal Income Taxes under Section 501(C) (3) of the IRS Code, attach a copy of letter of exemption.Non-profit public, and/or governmental organizations are not exempt from state unemployment insurance, unless certain requirements aremet. If you are unsure about your present or future unemployment insurance status, please contact us for assistance at (615)741-2486.

12. FAILURE TO PROPERLY COMPLETE THIS SECTION WILL RESULT IN RECEIVING THE HIGHEST PREMIUM RATE ASSIGNABLE.Briefly describe the major business activity of the account to be covered, listing any products produced or sold, or service provided.

Be as descriptive as possible. _____________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

YEAR JAN-MAR APR-JUNE JUL-SEPT OCT-DEC OCT-DECJUL-SEPTAPR-JUNEJAN-MARYEAR

Sample

INFORMATION FOR COMPLETING STATUS APPLICATION

Enclosed is a Report to Determine Status/Application for Employer Number. The Tennessee Employment SecurityLaw and Regulations requires each employing unit in Tennessee to file this report with the Department of Labor andWorkforce Development for the purpose of determining status. If you answer “Yes” to question 6(d) or any one of thequestions in items 7, 8 or 9 on the status application, you are liable for unemployment insurance coverage with thisdepartment. Please complete and submit the enclosed form as soon as you have paid wages for services performed inTennessee.

The requirements for liability are:

REGULAR BUSINESS EMPLOYERS

Items 7 A and B on the status application do not pertain to farm or household employees.

Item 7A. During some part of a day in each of twenty calendar weeks of a calendar year, did youemploy or do you expect to employ one or more persons? (The weeks need not be consecutiveand both full and part-time workers are counted.)

OR

Item 7B. Have you paid or do you expect to pay wages of $1,500 or more in any calendar quarter?

HOUSEHOLD EMPLOYERS

Item 8. Did you have or do you expect to have a calendar quarter in which you paid householdemployee(s) $1,000 or more in cash wages? If so, you are liable for all wages paid during

that year and the following calendar year.

AGRICULTURAL EMPLOYERS

Item 9A. During some part of a day in each of twenty weeks of a calendar year did you employ or doyou expect to employ ten or more persons? (The weeks need not be consecutive and both fulland part-time workers are counted.)

OR

Item 9B. Have you paid or do you expect to pay wages of $20,000 or more in any calendar quarter?

Leave the space under Item 1 for Federal Number blank if you have not yet been assigned a FEIN (Federal EmployerIdentification Number). You will receive a letter asking for this number after we establish your state account. Return the letterwith your FEIN when you receive the number from the Internal Revenue Service.

If you are completing quarterly reports and/or the Application for Transfer of Experience Rating (LB-0483), please returnthem in the same envelope with this application. DO NOT write in the box titled State Account Number if you are submittingquarterly Premium (LB-0456) and Wage (LB-0851) Reports along with this application. Your new number will be recordedhere when assigned.

Anyone who is paid for personal services by a corporation is considered to be an employee of the corporation even if thatperson is an officer and/or owns stock in the corporation.

NOTE: PLEASE BE SURE TO SIGN YOUR STATUS APPLICATION at the bottom and include the appropriate information.Also, complete both pages of your Status Application form.

Failure to complete both pages of the application or to provide sufficient information upon which tocorrectly classify the industry code will result in the highest new employer rate being assigned.(Revised 8/07)

Sample

Mail To: Employer ServicesTN Dept of Labor and Workforce Development220 French Landing DriveNashville TN 37243

PREMIUM RATE INFORMATION

New employers in Tennessee are initially subject to a “new employer” rate until their account has been subject topremiums and chargeable with benefits for thirty-six consecutive months ending on the computation date (December 31,of each year). They then become eligible, beginning on the next July 1, for a premium rate based on their individualreserve experience.

New employer rates are determined separately for each major industry group based on the combined reserve experienceof each industry group as a whole. New employer rates for each industry, like individual experience rates to eligibleemployers, are redetermined each year effective July 1. Presently, all industries, except construction, mining, andmanufacturing sectors 31 and 32, have a new employer rate of 2.7%. The new employer rates for construction, mining,and manufacturing are listed below.

July ‘01 - June ‘02 6.5% 10.0% 2.7%

July ‘02 - June ‘03 7.0% 10.0% 6.5%

July ‘03 - June ‘04 7.5% 10.0% 7.5%

July ‘04 - June ‘05 06.0% 07.0% 6.0% 2.7% 6.5%

July ‘05 - June ‘06 06.0% 08.0% 6.0% 2.7% 6.0%

July ‘06 - June ‘07 06.0% 07.5% 06.0% 02.7% 06.0%

July ‘07 - June ‘08 05.0% 06.5% 06.0% 02.7% 06.0%

NAICS Manufacturing Sector 31 includes food, beverage, and tobacco products, as well as textiles,leather, and apparel products.

NAICS Manufacturing Sector 32 includes wood products, paper products, printing and related supportactivities, petroleum and coal products, chemical manufacturing, plastics and rubber products, andnonmetallic mineral products.

NAICS Manufacturing Sector 33 includes metal products, machinery, computer and electronic products,electrical equipment, appliances, transportation equipment, and furniture manufacturing.

Rate Year Construction Mining Manufacturing

(Revised 8/07)

Sector 31 Sector 32 Sector 33

As of July 1, 2004, new employer premium rates are based on the combined reserve experience of the NorthAmerican Industry Classification System (NAICS) sector of which the employer is a part. Under NAICS,manufacturing is split into three separate sectors. NAICS-based new employer rates are shown on the tablebelow.

Rate Year Construction Mining Manufacturing

Taxable wages are the first $7,000 of gross wages paid to each employee per year.

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