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 BUREAU OF LABOR STATISTICS
  Annual Refiling Survey
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Welcome to the Annual Refiling Survey
Legal Name :
UI Account Number :
State : Nevada

Industry Verification Form, BLS 3023-NVS
Form Approved, O.M.B.
No. 1220-0032

Nevada Dept of Employment, Training & Rehab
In cooperation
with the U.S. Department of Labor.

This report is mandatory under Nevada State Law, NRS 612.220, and is authorized by law, 29 U.S.C. 2. Your cooperation
is
needed to make the results of this survey complete, accurate, and timely.

Note: If this firm is NO LONGER IN BUSINESS, please complete this report in reference to the firm's previous activity.

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The purpose of this report is to update
information on your products or services. The information will be used
to ensure that
we assign the correct North American Industry
Classification System (NAICS) code to this business location and that
our
records contain the correct name and address. The information
collected on the form by the Bureau of Labor Statistics and
the State
agencies cooperating in its statistical programs will be used for
statistical and Unemployment Insurance program
purposes and other
purposes in accordance with law.

The Bureau of Labor Statistics, its employees, agents, and partner statistical agencies, will use the information you provide
for statistical purposes only and will hold the information in confidence to the full extent permitted by law. In accordance
with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other
applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. This report
is authorized by law, 29 U.S.C. §2. Your cooperation is needed to make the results of this report comprehensive, accurate,
and timely.

Time of completion is estimated to vary from 2 to 30 minutes with an average of 5 minutes per account. This estimate
includes time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing this information. If you have any comments regarding these estimates, or any other aspect of this
survey, please contact your State Agency which is located at the bottom of this page. You are not required to respond to
the collection of information unless it displays a currently valid O.M.B. number. The O.M.B. control number for this survey is
1220-0032.

  If you have questions about the Annual Refiling Survey, please contact:

     Nevada Dept of Employment, Training & Rehab

     Research And Analysis Bureau

     500 E. Third Street
     Carson City, NV 89713-0021

     PH: 775-684-0499
 FAX: (775) 684-0342
  If you have questions about the website, please send an e-mail to [email protected]   |   Version: 1.4

 BUREAU OF LABOR STATISTICS
  Annual Refiling Survey
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Address and Contact Verification Page
Legal Name :
UI Account Number :
State : Nevada

Please review the information below, and make corrections where needed.

Business Mailing Address

Please review the address below. If the information is incorrect please enter updated information.   (*Required Field)
Attention :
Legal Name :
Trade Name
:

*Street
Address :
Additional
Address
Information
:

*City :
*State :

NV
NV
NH

*Zip Code :

Physical Location Address

Please review the address below. If the information is incorrect please enter updated information. Do not include P.O.
Box or out of State addresses.

This business has one or more Physical Locations in Nevada.
Copy Business Mailing Address

*Street
Address :

Additional
Address
Information
:

*City :
State :

NV

*Zip Code :

This business has more than one physical location in Nevada. Do not count client sites or offsite projects that will
last less than a year.

This business has employees working in Nevada but no physical location in Nevada.

Please select the County, Township, Island, or Parish where you business is physically located. If you do not know it or it is
not listed, please check the box below.

*County :

Not applicable

I don't know my County or I don't see my County listed above.
Contact Information

Please provide your contact information.

*Contact

Name :

*Phone
Number :
*Contact

Email :

*Confirm

Email :

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  If you have questions about the Annual Refiling Survey, please contact:

     Nevada Dept of Employment, Training & Rehab

     Research And Analysis Bureau

     500 E. Third Street
     Carson City, NV 89713-0021

     PH: 775-684-0499
 FAX: (775) 684-0342
  If you have questions about the website, please send an e-mail to [email protected]   |   Version: 1.4

 BUREAU OF LABOR STATISTICS
  Annual Refiling Survey
Logout

Main Business Activity
Legal Name :
UI Account Number :
State : Nevada

Please review the description of your main business activities, goods, products, or services in this State. This is a general
description of your main business activity and may not be an exact match. There may be activities listed in which you do not
participate. If the information displayed below is correct for a majority of your business, please check "YES". If it is incorrect
for a majority of your business, please check "NO" and click the continue button.

Drinking Places, Alcoholic Beverages
Preparing and serving alcoholic beverages for immediate consumption
in bars, taverns, night clubs, or drinking places. These
establishments may also provide limited food service.
DOES NOT INCLUDE: Providing alcoholic beverage in combination with
food services in restaurant operating a civic or social association
with a bar for association members; retailing package; alcoholic
beverages for later consumption; or operating alcohol-free
discotheques or dance clubs.

722410

*Does the description above accurately reflect your main business activity during the past 12 months?

YES

NO
If you answer 'NO' you will be able to choose your correct economic activity on the next page.
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and Continue
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Continue

  If you have questions about the Annual Refiling Survey, please contact:

     Nevada Dept of Employment, Training & Rehab

     Research And Analysis Bureau

     500 E. Third Street
     Carson City, NV 89713-0021

     PH: 775-684-0499
 FAX: (775) 684-0342
If you have questions about the website, please send an e-mail to [email protected] | Version: 1.4

 BUREAU OF LABOR STATISTICS
  Annual Refiling Survey
Logout

Main Business Activity Selection
Legal Name :
UI Account Number :
State : Nevada

Step 1:
Search for your Main Business Activity.
Please type in a key word, click "Search", and select the Main Business Activity that most accurately reflects your business
(simple key words work best). Example: If you are a Fast Food Restaurant, type "Restaurant" into the search box. If you do
not see an appropriate description, you can select "NO" in Step 2 and move on to Step 3.
Type your key word search:

Search

Step 2: Verify your Main Business Activity.

*Does the Main Business
Activity selected above accurately reflect your business?
YES, the Main Business Activity selected above accurately represents my business.
NO, I am unable to find an applicable Main Business Activity description.

Step 3: Describe your Main Business Activity.

*Please help us verify your selection in Step 2 by entering a brief description of your main business activities, goods,

products, or services in this State, as though you were telling a prospective employee what you do. In addition, please
provide the approximate percentage of sales or revenues resulting for each description. Percentages should total 100%.
(Maximum 255 Characters)

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Saveand
and Continue
Save
Continue

  If you have questions about the Annual Refiling Survey, please contact:

     Nevada Dept of Employment, Training & Rehab

     Research And Analysis Bureau

     500 E. Third Street
     Carson City, NV 89713-0021

     PH: 775-684-0499
 FAX: (775) 684-0342

If you have questions about the website, please send an e-mail to [email protected] | Version: 1.4

 BUREAU OF LABOR STATISTICS
  Annual Refiling Survey
Logout

Summary Page
Legal Name :
UI Account Number :
State : Nevada
Attention: Your report is not yet submitted.
You must click the Submit button at the bottom of this page to
submit
your data to BLS.

This is a summary of the data that you are about to submit. If you are satisfied with the information below,
please click the "Submit Data to BLS" button. If you need to make any changes, please click the "Edit" link
to return to the appropriate screen.

Please remember to print this page for your records.

Print

Main Business Activity
Industry Verification:

Drinking Places, Alcoholic Beverages

Edit

Contact and Address Information
Business Mailing Address
Attention :
Trade Name :
Street Address :
Additional Address
Information :
City :
State :
Zip Code :

Physical Location Address
Street Address :
Additional Address
Information :
City :
State :
Zip Code :
County :

Edit

Contact Information
Contact Name :
Contact Phone :
Contact Email :

Submit Data to
Submit
Data
toBLS
BLS

  If you have questions about the Annual Refiling Survey, please contact:

     Nevada Dept of Employment, Training & Rehab

     Research And Analysis Bureau

     500 E. Third Street
     Carson City, NV 89713-0021

     PH: 775-684-0499
 FAX: (775) 684-0342
  If you have questions about the website, please send an e-mail to [email protected]   |   Version: 1.4