Instructions (Continued)

number in item 3, if you are a sole
proprietor.

Note: If a corporation.—Enter in item
1 the corporate name as set forth in its
charter, or other legal document creating it.

If a trust.—Enter the name of the trust
in item 1 and the name of the trustee in
item 2. Also, see instructions for item 10.

If an estate of a decedent, insolvent,
etc.—Enter the name of the estate in item
1 and the name of the administrator or
other fiduciary in item 2. Also, see instruc-
tions for item 10.

If a partnership.—Enter the legal name
(not trade name) of the partnership, ac-
cording to the partnership agreement, in
item 1 and the first name, middle initial,
and last name of a general partner in item
2. A general partner should sign this appli-
cation.

Item 9, Governmental.—Check if or-
ganization’ is a State, county, school dis-
trict, municipality, etc., or is related to
such entities, for example: county hospi-
tal, city library, etc.

Nonprofit organization (other than gov-
ernmental).—Check if organized for reli-

Page 4

gious, charitable, scientific, literary, educa-
tional, humane, or fraternal purposes, etc.
Generally, a nonprofit organization must
file an application for exemption from Fed-
eral income tax with the Internal Revenue
Service. Details on how to apply are in IRS
Publication 557.

Item 10.—For trusts, enter the date the
trust was legally created.

For estates, enter the date of death of
the decendant whose name appears in
item 1.

Item 13.—Describe the kind of business
farried on by the applicant. See examples
elow.

(a) Governmental.—State type of gov-
ernmental organization, whether a State,
county, school district, municipality, etc.,
or relationship to such entities, for ex-
ample: county hospital, city library, etc.

(b) Nonprofit (other than governmen-
tal).—State whether organized for reli-
gious, charitable, scientific, literary, educa-
tional, or humane purposes and state the
principal activity, for example: religious
organization—hospital; charitable organi-
zation—home for the aged; etc.

‘Yk US, GOVERNMENT PRINTING OFFICE : 1979-O-263-409

(c) Mining and quarrying—State the
process and the principal product, for ex-
ample: mining bituminous coal, contract
drilling for oil, quarrying dimension stone,
etc,

(d) Contract __construction.—State
whether general contractor or special trade
contractor and show type of work normally
performed, for example: general contrac-
tor for residential buildings, electrical sub-
contractor, etc.

(e) Trade.—State the type of sale and
the principal line of goods sold, for ex-
ample: wholesale dairy products, manufac-
turer’s representative for mining machin-
ery, retail hardware, etc.

(f) Manufacturing.—State type of es-
tablishment operated, for example: saw-
mill, vegetable cannery, etc. In item 16,
state the principal product manufactured
and raw material used.

(g) Other activities——State exact type
of business operated, for example: adver-
tising agency, farm, labor union, real estate
agency, steam laundry, rental of coin-oper-
ated vending machines, investment club,
etc.

Return both parts of this form to the
Internal Revenue Service—your employer
identification number will be mailed to you.


E.l. NO. 22-1832268 -¥e US, GOVERNMENT PRINTING OFFICE : 1979-O-263-409

For clear copy on both parts, please typewrite or print with ball point pen and press firmly (See Instructions on pages 2 and 4)

Form SS—4- (Rev. 3-79) Application for Employer Identification Kumber

Department of the Treasury

Inteonal Revenue Serine (For use by employers and others as explained in the instructions)

1 Name (True name as distinguished from trade name. If partnership, see instructions on page 4.)

3 Social security number, if sole proprietor

2 Trade name, if any (Name under which business is operated, if different from item 1.)

‘4 Address of principal place of business (Number and street) 5 Ending month of accounting year
6 City and State 7 ZIP code 8 County of business location
9 Type of organization [J Individual] Trust” [J Partnership [Other (Specify) 10 Date you acquired or started this
[J Governmental (See Nonprofit organization Corporation business (Mo., day, year)
Instructions on page 4) [J] (See instructions on page 4) LC]

11 Reason for applying 12 First date you paid or will pay wages
Started new Purchased CO other for this business (Mo., day, year)
business going business (Specify)

13 Nature of business (See Instructions on page 4) 14 Do you operate more than one place

of business? ves [Ne

15 Peak number of employees | Nonagricultural Agricultural Household 16 If nature of business is manufactur.

expected in next 12 months ing, state principal product and raw

material used.

(if none, enter

17 To whom do you sell most of your products or services?
Business General CD Other
establishments public (specify)

18 Have you ever applied for an identification num-
ber for this or any other bu:

If “Yes,” enter name and trade name (if any). DP
Also enter the approximate date, city, and State

where you first applied and previous’ number if
ne:n.

Date Signature and title Telephone number

Please leave Geo, Ind, Class Size Reas. for appl.
blank >

Part 1



instructions

Who must files Every person who has
not previously obtained an identification
number and who (a) pays wages to one or
more employees, or (b) is required to have
an identification number for use on any re-
turn, statement, or other document, even
though not an employer, must file a Form

Trusts, estates, corporations, partner-
ships, nonprofit organizations (such as
churches, clubs, etc.), and similar non-
individual persons must use employer
identification numbers even if they have no
employees.

Individuals who file Schedules C or F
(Form 1040) must also use employer
identification numbers if they are required
to file excise, alcohol, tobacco, firearms,
or employment tax returns.

Only one application for an identifica-
tion number should be filed, regardless of
the number of establishments operated.
This is true even though the business is
conducted under one or more business or
trade names. Each corporation of an affili-
ated group must be treated separately, and
each must file a separate application. If a
business is sold or transferred and the new
owner does not have an identification num-
ber, the new owner cannot use the identi-
fication number assigned to the previous
owner, and must file an application on
Form SS-4 for a new identification
number.

Page 2

Where to file—
Hf your princi le
neleothce of eeency,
or legal residence in File with the
the case of an individ-

Internal Revenue

ual, is located in: ‘Service Center at:

New Jersey, New York
City and counties of
‘Nassau, Rockland,

si and West-

v2 Holtsville, NY
chester

00501

New York (all other
counties), Connecticut,
Maine, Massachusetts,
New Hampshire,
Rhode Island, Vermont

Andover, MA

05501

District of Columbia,
Delaware, Maryland, Philadelphia, PA
Pennsylvania

19255

Alabama, Florida,
Georgia, ‘Mississippi,
South Carolina

Atlanta, GA

31101

Michigan, Ohio Cincinnati, OF

45999

Arkansas, Kansas,
Louisiana, New Mex-
ico, Oklahoma, Texas

Austin, TX

73301

Alaska, Arizona, Col-
corado, Idaho, Minne-
sota, Montana, Ne-
braska, Nevada, North
Dakota, Oregon, South
Dakota, Utah, Wash-
ington, Wyoming

Ogden, UT

84201

EE, Som ov bo oom
California, Hawaii Fresno, CA 93888
Nou Carolinas Pen- ey

nessee, Virginia, mphis, TN 37501

West Virginia

If you have no legal residence, principal
place of business, or principal office or
agency in any Internal Revenue district, file
your return with the Internal Revenue Serv-
ice Center, Philadelphia, PA 19255.

When to file-—(a) Those who pay wages
must file on or before the seventh day after
the date on which business begins. (b)
Others must file in sufficient time for the
identification number to be included in re-
turn, statement, or other document.

Specific Instructions

Items 1, 2, and 3.—Enter in item 1 the
true name of the applicant and enter in
item 2 the trade name, if any, adopted for
business purposes. For example, if John
W. Jones, an individual owner, operates a
restaurant under the trade name of “Busy
Bee Restaurant,” “John W. Jones” should
be entered in item 1 and “Busy Bee Res-
taurant” in item 2. Enter the social security

(Continued on page 4)


Form SS—4 (Rev. 3-79) Application for Employer Identification Number

Department of the Treasury (€or use by employers and others as explained in the Instructions)

Internal Revenue Service

1 Name (True name as distinguished from trade name. If partnership, see instructions on page 4.)

2 Trade name, if any (Name under which business is operated,

different from item 1.)

3 Social security number, if sole proprietor

4 Address of principal place of business (Number and street)

a

Ending month of accounting year

6 City and State 7 ZIP code 8 County of business location
9 Type of organization [yj individual” 7] Trust [7] Partnership [] Other (specify) 10 Date you acquired or started this
[LJ Governmental (See, Nonprofit organization Corporation business (Mo., day, year)
Instructions on page 4) __(_] (See instructions on page 4) LJ

11 Reason for applying
Started new Purchased.
business going business

OO oth
(specify)

12 First date you paid or will pay wages
for this business (Mo., day, year)

13 Nature of business (See Instructions on page 4)

14 Do you operate more than one place
of business? oy Yes [Ne

15 Peak number of employees | Nonagricultural
expected in next 12 months
(if none, enter 0")

‘Agricultural Household

17 To whom do you sell most of your products or services?

Business General
establishments public

OO Other
Gpecify)

16 If nature of business is manufactur.
ing, state principal product and raw
material used.

18 Have you ever applied for an identification num-
ber for this or any other business? ["] Yes [] No

If "Yes," enter name and trade name (if any). Db
Also enter the approximate date, city, and State

where you first applied and previous’ number if
own.

Date Signature and title

Telephone number

Please leave Geo. Ind,

blank pb

Class

Reas. for appl. Part Il