Pre - audit Questionnaire BWC - 7664 (Rev. Feb. 25 , 2019 ) U - 158 Employer name Federal ID BWC policy number Address City State ZIP code Phone Cell phone Fax Email Website 1. I ndicat e the IRS tax document you file. 1040 Individual 1120 Corporation 990 Not for Profit 1065 Partnership 1120 - S S - Corporation Other 2. Lis t active officers/owners/partner by name, title, duty and to which manual class reported for the audit period. Name T itle Class code Duties 3. Has the business or a portion of the business been sold/purchased within the last three years? Yes No 4. Are you in or have you been in a PEO lease ? Yes No (If yes, please provide effective dates.) 5. If there are multiple e ntities covered by this policy, please list legal names and federal ID numbers. 6. List any associated or commonly owned companies and their BWC policy numbers. 7. Do you have locations outside of Ohio? Yes No ( P lease p rovide addresses and phone numbers.) 8. Did you have Ohio employees working outside the state in the audit period? Yes No 9. Describe your services or products, including your methods of operations. 10. L ist the number of clerical employees : Outside sales employees : Drivers : 11. I ndicate the number of W - 2s issued in Ohio for the most recent completed tax year. 12. I ndicate the number of 1099s* issued in Ohio for the most recent completed tax year . * Auditor will need contracts/invoices . 13. Do you pay any individuals for whom you do not issue a 1099 or W2 ? Yes No Questionnaire completed by: Date: Signature U se an attachment if there is not sufficient space provided for some answers. American LegalNet, Inc. www.FormsWorkFlow.com