Written Authorization
To Represent Employing Unit In Its Relations
With the Texas Workforce Commission
Client Number Branch Number Sales ID Number
Paychex Use Only / Employer InformationAttorney In Fact Paychex, Inc.
TWC Acct. Number 01-971802-6
Address911 Panorama Trail South
Rochester, NY 14625-0397 / (1) Employer’s TWC Acct. Number
(2) Employer’s Federal ID Number
(3) Contact Name
(4) Contact Phone Number
BY THIS INSTRUMENT,(5),
(Name of Employer)
an employing unit which is a (6), whose address is
(Corporation, Partnership, Individual, etc.)
(7),
appoints Paychex ®, Inc., whose TWC ACCOUNT NO. is 01-971802-6, and whose address is 911 Panorama Trail South, Rochester, NY 14625, its lawful representative to represent it in its relations with the Texas Workforce Commission, and specifically authorizes said representative to transact any and all business as between grantor of said authorization and said Commission to do any and all acts necessary, excluding litigation in court.
This Written Authorization shall be in full force and effect until such time as a Revocation of Written Authorization, Form C-43, revoking it is filed in the office of Said Commission at Austin, Texas. (Revocable by either party, the Grantor or Grantee.)
*(8)
Printed name, signature and title (owner, partner, officer, etc.) of person signing for employing unit.(Refer to Instruction #8 on following page)
*(9)SUBSCRIBED AND SWORN to before me on thisday of, 20
(Month)(Year)
*(10)
(Signature of Notary Public)
*(Notary Seal)*(11)Notary Public, State of
*My Commission expires, 20
(Month & Day) (Year)
Notice:This Written Authorization should be executed in triplicate. Original to be filed with the Texas Workforce Commission, Austin, Texas. One copy to be retained in the employer’s files and one to be retained in Grantee’s file.
*MANDATORY INFORMATION
Form C-42(1199)Inv.No.520950Instructions ON REVERSE SIDE
Page 1 of 2TP0018 6/06
Instructions For:
Written Authorization
To Represent Employing Unit In Its Relations
With the Texas Workforce Commission
Description of information required on page 1 of document.
- Failure to complete the items with an asterisk will result in the document being returned as incomplete. Forms marked “NOT APPROVED” will be returned with an attached form letter indicating the reason document is being returned. A new, completed form must be submitted.
- One original form is required. Copies or faxes are not accepted. No marks on upper right corner of form.
1.Enter the Account Number assigned to the Employer by Texas Workforce Commission. if the Employer does not have a number, Form C-1, Status Report, should be submitted. Employers can establish a TWC Account Number through TWC website.
2.Enter the Employer’s Federal Employer ID Number.
3.Enter the name of the contact person responsible for answering any questions pertaining to state unemployment taxes.
4.Enter contact’s telephone number including area code.
5.Enter official name of Employing Unit as Corporation, Individual, Partnership, etc. Must be the legal business name. DBAs, initials, or abbreviations are not accepted. (Name of entity must match the name on the TWC C-1 Status Form.)
6.Enter type of ownership (Corporation, Partnership, Sole Proprietorship, Trust, Limited Liability Company, Estate, etc.). (Type of ownership must match the entity type on the TWC C-1 Status Form.)
7.Enter employer’s complete physical mailing address.
*8.Signature: A Written Authorization must be signed by (1) the individual, if the employer is a sole proprietor; (2) the president, vice president, or other principal officer, if the employer is a corporation; (3) a responsible and duly authorized member or officer having knowledge of its affairs, if the employer is a partnership or other unincorporated organization; or (4) the fiduciary, if the employer is a trust or estate. The Written Authorization must also be acknowledged before a Notary Public. (Those authorized to sign the Written Authorization are: President, Vice President, Secretary (officer), Secretary-Treasurer, Assistant Secretary, Assistant Treasurer, Administrator, Directory (any type), Controller, Assistant Controller, Chairman, Officer, Trustee/Trust, CEO, CFO, COO, Executive Director, Owner, Partner, General Partner, Principal, Manager, Member)
*9.Enter sworn date.
*10.Signature of Notary Public. Original notary signature and stamp required. Copies are not accepted.
*11.Enter state in which Notary Public is authorized and expiration date (Month, Day and Year) of commission.
What’s New or Reminders:
- Line 8 requires the officer’s printed name, in addition to the signature and title.
- TWC suggests the Written Authorization executed in triplicate. A third original should be kept in the Grantee’s (Paychex) file.
- An entity can have only one TWC account number, regardless of how many entities are owned. There can be only one FEIN for one TWC account number.
- If an employer changes entity types (such as sole proprietor to corporate), the employer must apply for a new TWC account number.
Page 1 of 2TP0018 6/06