State of New Mexico   Department of Labor  EMPLOYMENT SECURITY DIVISION UNEMPLOYMENT INSURANCE BUREAU TAX SECTION TAX CLEARANCE REQUEST for purposes of corporate Dissolution or Withdrawal Send to: New Mexico Department of Labor ES Section Supervisor, Office sub-section(Clearance) PO Box 2281 Albuquerque, New Mexico 87103 1. Corporation dissolving or withdrawing from New Mexico Name: _________________________________________________________ Federal Employer Identification number :_______________________________ Public Regulation Number: _________________________________________ Address:_________________________________________________________ City, State, Zip :____________________________________________________ 2. Has the above corporation ever paid wages in New Mexico? No Yes If No, proceed to item #5 If Yes, continue to item #3 3. Has this corporation ever been registered with the New Mexico Department of Labor to pay unemployment Yes insurance taxes? No If Yes, Please provide the Employer Account Number:_________________________ Last date wages were paid in New Mexico: __________________________________ If No, please complete form ES-802, Status Report in its entirety and return with this request. Yes 4. Has final wage report and monies been submitted: No If no please submit final report and monies due with this request 5. Mailing address for Clearance Certificate if different from above address: Address:______________________________________________________________ City, State, Zip _________________________________________________________ 6. Requested by: Name and title(Print):___________________________________________________ Phone number ______________ Fax number______________ Email_______________________ 7. Signature: __________________________________________________________ OFFICE USE ONLY No Wages Paid in New Mexico, OK for Clearance Wages Paid in New Mexico, OK for Clearance because: Account Number Inactive No Delinquency File by employer number File by Alpha American LegalNet, Inc. www.FormsWorkflow.com