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HomeMy WebLinkAboutResolutions - R-78-3 - 01/20/1978 - Unemployment Insuance 77) W.ck 119.-7;39 source: 4-7cc— 3 State of Illinois - Department of tabor Date: 1-20-78 Bureau of Employment Security DIVISION OF UNEMPLOYMENT INSURANCE 910 South Michiga,i Avenue (Do Not Use) Chicago, Illinois 60605 A/C No. • LIAB. Date Qtr. Sec. Name, Address & Federal Employer Identification Number: Det. y Date Posted By Date City of McHenry _ -- . - Cleared By Date 1111 N. Green St. ' McHenry, IL ' 60050 . 36-6005993 REPORT TO ESTABLISH LIABILITY FOR LOCAL GOVERNMENT ENTITIES UNDER THE ILLINOIS UNEMPLOYMENT INSURANCE ACT 1. Legal Name of Local Government Entity: City of McHenry 2. Address and Telephone No: 1111 N. Green St. �" (Street and limber or Rural Route) McHenry McHenry Illinois 60050 815-385-0947 (City or Town) _ _ (County) (State) . . (Zi Code) (!eiephone lumber) 3. Address to Which Correspondence Should be Mailed-if-Different From Above: Same as above (Street and Number) (City) i (County , , (State) (Zip Code) 4. Name, • Capacity:-and Telephohe Number of Person Who May Be Contacted For Information: Mrs. Sharon Reid, . Payroll Clerk 815-385-0947 5. Enter Your Federal Employer Identification Number Under Which You File Federal Social Security Returns (Form 941) If Not Shown In The Box Above Your Name and Address: • 36-6005993 6. What Is The Form Of Your Organization: El POLITICAL-SUBDIVISION ❑IN5rEUMENTALITY* ©MUNICIPAL CORPORATION ❑OTHER (Specify) ' *If An Instrumentality, Of What Political Entity? 6A. Date Created: '5-15-23 How Created (Specify) 7. Do You Have Taxing Power? ©YES ❑NO If "NOR Answer The Two Questions Below: . What Is Your' Source Of Revenue? Who Has The.Authority To Establish Policy For Your Unit? - - - • 8. Enter The Following Information For The Officers Of Your Organization: MAME: TITLE: Joseph B. Stanek Mayor Barbara E. Gilpin City Clerk • William Brda City Treasurer • Narusis & Narusis City Attorney • g. Date That you Began.Employing Workers In'The State Of Illinois If Later Than — January 1, 1978- 10. As A Local Goverenmental Entity You Are Liable For The Payment Of Contributions -.-_._ Under The Provisions Of The Illinois Unemployment Insurance Act. Are You Interested In The Option Of Reimbursement Of Benefits Paid To Your Former Workers In Lieu Of Paying Contributions On The Wages Paid To Your Workers? DYES ADNO -If Your Answer Above Is "YES", Please Complete The Enclosed Form UC-5(LG) And Re- turn It To Us. 11. Enter Below The Information For.EACH Of Your Facilities. - ;"-(a) : ; (b) (c) LOCATION EMPLOYEES ME OF iiCT1YIIY AT E/CH ADDRESS ' ' Street and Number or Rural Route, City County Average Use term that best describes or Town, and Zip Code (List each in Number your organization such as: Location or Branch in ill inois) _ __ -. Illinois ._.. ._at - hospital,-schools,- l ibrary,-City. Each Address 1111 N. Green, McHenry 60050 McHenry -- P.T.-31 City F.T.-49 1 CERTIFICATION: I hereby certify that the information contained 'in this report and in any sheets attached hereto is true and correct. • City of McHenry - - 'Legal Name of Organization This report Dust be slow! by a, officer. Signed by " If signed by any other person, evidence _ of the authorit y for such person rust be • Official Title City Clark . attached. • • Date signed 1-20-78 - RETURN THIS COPY IN THE ENCLOSED ENVELOPE