X hits on this document

48 views

0 shares

1 downloads

0 comments

8 / 16

APPLICATION FOR DEALERS LICENSE

STATE OF RHODE ISLAND ‐‐ DIVISION OF MOTOR VEHICLES Dealer Section 600 New London Avenue ,Cranston, RI 02920-3024 www.dmv.ri.gov

EMPLOYEE LIST

Corporate Name:

_____________________________________________________________________

D/b/a Name:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

List all employees who are presently on your payroll and receive W-2 forms:

Name:

Drivers License#

_______________________________________________

_____________________

Name:

Drivers License#

_______________________________________________

_____________________

_______________________________________________

_____________________

_______________________________________________

Drivers License#

______________________

Name:

Name:

Drivers License#

Name:

Drivers License#

_______________________________________________

______________________

_______________________________________________

______________________

_______________________________________________

Drivers License#

______________________

Name:

Name:

Drivers License#

Name:

_______________________________________________

Drivers License#______________________

Name:

Drivers License#

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

______________________

TOTAL NUMBER OF EMPLOYEES LISTED:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

PLEASE SUBMIT A NEW LIST EVERY TIME THERE IS AN EMPLOYEE CHANGE.

1099 FORMS ARE NOT ACCEPTED IN THE DEALERS’ LICENSE & REGULATIONS OFFICE

This form must have the companion Workers’ Compensation List and stamped copies of the DWC-11 forms for employees excluding themselves from Workers’ Compensation attached.

Have you or any of your employees had any criminal charges or violations of Rhode Island General Laws lodged against them in court within the last 12 months? Yes____ No____ If yes, please explain in detail on additional sheet.

I, the undersigned, hereby declare under the penalty of perjury, that I have examined this statement regarding the number of employees, and to the best of my knowledge this is true and correct. Rhode Island General Laws §31-11-17.

State of Rhode Island County:_______________

_______________________________________ Signature of Owner, Partner or Corporate Office

Subscribed and sworn to before me this

_______day of

20

_____________ _____

_________________________________ Notary Public DLR013 – DATED 08-25-10

______________________________ Commission Expires

Page 7

Document info
Document views48
Page views48
Page last viewedMon Dec 05 12:13:30 UTC 2016
Pages16
Paragraphs476
Words6727

Comments