Form SS-4 (Rev. 8:89)

Page 2

Individual. —Check this box if the individual
files Schedule C or F (Form 1040) and has a
Keogh plan or is required to file excise,
employment, or alcohol, tobacco, or firearms
returns. If this box is checked, enter the
individual’s SSN (social security number) in
the space provided.

Plan administrator.—The term plan
administrator means the person or group of
persons specified as the administrator by the
instrument under which the plan is operated.
If the plan administrator is an individual, enter
the plan administrators’s SSN in the space
provided

New withholding agent.—lf you are a new
withholding agent required to file Form 1042,
check the “other” box and enter in the space
provided “new withholding agent.”

REMICs,—Check this box if the entity is a
real estate mortgage investment conduit
(REMIC). A REMIC is any entity:

1.To which an election to be treated as a
REMIC applies for the tax year and all prior tax
years,

2. 1n which all of the interests are regular
interests or residual interests,

3. Which has one (and only one) class of
residual interests (and all distributions, if any,
with respect to such interests are pro rata),

4. In which as of the close of the 3rd month
beginning after the startup date and at all
times thereafter, substantially all of its assets
consist of qualified mortgages and permitted
investments,

5. Which has a tax year that is a calendar
year, and

6. With respect to which there are
reasonable arrangements designed to ensure
that: (a) residual interests are not held by
disqualified organizations (as defined in
section 860E(e)(5)), and (b) information
necessary for the application of section
860E(e) will be made available.

For more information about REMICs see the
Instructions for Form 1066

Personal service corporations. —Check this
box if the entity is a personal service
corporation. An entity is a personal service
Corporation for a tax year only if

1, The entity is a C corporation for the tax
year,

2. The principal activity of the entity during
the testing period (as defined in Temporary
Regulations section 1.441-4T) for the tax year
is the performance of personal service,

3. During the testing period for the tax year,
such services are substantially performed by
employee-owners, and

4. The employee-owners own 10 percent of
the fair market value of the outstanding stock
in the entity on the last day of the testing
period for the tax year.

For more information about personal service
corporations, see the instructions to Form
1120, U.S. Corporation Income Tax Return,
and Temporary Regulations section 1.441-4T.

Other corporations, —This box is for any
corporation other than a personal service
corporation. If you check this box, enter the
type of corporation (such as insurance
company) in the space provided.

Other nonprofit organizations. —Check this
box if the nonprofit organization is other than a
church or church-controlled organization and
specify the type of nonprofit organization (for
example, an educational organization.)

Group exemption number (GEN).—If the
applicant is a nonprofit organization that is a
subordinate organization to be included ina
group exemption letter under Revenue
Procedure 80-27, enter the GEN in the space
provided. If you do not know the GEN, contact
the parent organization for it. GEN is a four-
digit number. Do not confuse it with the nine-
digit EIN.

Line 9.—Check only one box. Do not enter
N/A.

Started new business.—Check this box if
you are starting a new business that requires
an EIN. If you check this box, enter the type of
business being started. DO NOT apply if you
already have an EIN and are only adding
another place of business.

Changed type of organization.—Check this
box if the business is changing its type of
organization, for example, if the business was
a sole proprietorship and has been
incorporated or has become a partnership. If
you check this box, specify in the space
provided the type of change made, for
example “from sole proprietorship to
partnership.”

Purchased going business.—Check this box
if you acquired a business through purchase.
Do not use the former owner's EIN. If you
already have an EIN, use that number.

Hired employees.—Check this box if the
existing business is requesting an EIN because
it has hired or is hiring employees and is
therefore required to file employment tax
return for which an EIN is required. DO NOT
apply if you already have an EIN and are only
hiring employees.

Created a trust.—Check this box if you
created a trust, and enter the type of trust
created,

Created a pension plan.—Check this box if
you have created a pension plan and need this
number for reporting purposes. Also, enter the
type of plan created.

Banking purpose.—Check this box if you
are requesting an EIN for banking purpose only
and enter the banking purpose (for example,
checking, loan, etc.).

Other (specify). —Check this box if you are
requesting an EIN for any reason other than
those for which there are checkboxes and
enter the reason.

Line 10.—If you are starting a new business,
enter the starting date of the business. If the
business you acquired is already operating,
enter the date you acquired the business.
Trusts should enter the date the trust was
legally created. Estates should enter the date
of death of the decedent whose name appears
online 1.

Line 11.—Enter the last month of your
accounting year or tax year, An accounting.
year or tax year is usually 12 consecutive
months, It may be a calendar year or a fiscal
year (including a period of 52 or 53 weeks). A
calendar year is 12 consecutive months
ending on December 31. A fiscal year is either
12 consecutive months ending on the last day
of any month other than December or a 52-53
week year. For more information on
accounting periods, see Pub, 538, Accounting
Periods and Methods.

Individuals. —Your tax year generally will be
a calendar year.

Partnerships.—Partnerships generally
should conform to the tax year of either (a) its
majority partners; (b) its principal partners;

(c) the tax year that results in the least
aggregate deferral of income (see Temporary
Regulations section 1.706-17); or (d) some
other tax year, if (i) a business purpose is
established for the fiscal year, or (ii) the fiscal
year is a “grandfather” year, or (iii) an election
is made under section 444 to have a fiscal
year. (See the Instructions for Form 1065,
U.S. Partnership Return of Income, for more
information.)

REMICs,—Remics must have a calendar
year as their tax year.

Personal service corporations. —A personal
service corporation generally must adopt a
calendar year unless:

(1) It can establish to the satisfaction of the
Commissioner that there is a business purpose
for having a different tax year, or

(2) It elects under section 444 to have a tax
year other than a calendar year.

Line 12.—If the business has or will have
employees, enter on this line the date on
which the business began or will begin to pay
wages to the employees. If the business does
not have any plans to have employees, enter
N/A on this line.

New withholding agent.—Enter the date
you began or will begin to pay income toa
nonresident alien. This also applies to
individuals who are required to file Form 1042
to report alimony paid to a nonresident alien.
Line 15.—Generally, enter the exact type of
business being operated (for example,
advertising agency, farm, labor union, real
estate agency, steam laundry, rental of
coin-operated vending machine, investment
club, etc.).

Governmental.—Enter the type of
organization (state, county, school district, or
municipality, etc.)

Nonprofit organization (other than
governmental).—Enter whether organized for
religious, educational, or humane purposes,
and the principal activity (for example,
religious organization—hospital, charitable).

Mining and quarrying. —Specify the process
and the principal product (for example, mining
bituminous coal, contract drilling for oil,
quarrying dimension stone, etc.).

Contract construction. —Specify whether
general contracting or special trade
contracting. Also, show the type of work
normally performed (for example, general
contractor for residential buildings, electrical
subcontractor, etc.).

Trade.—Specify the type of sales and the
principal line of goods sold (for example,
wholesale dairy products, manufacturer's
representative for mining machinery, retail
hardware, etc.)

Manufacturing.—Specify the type of
establishment operated (for example, sawmill,
vegetable cannery, etc.).

Signature block.—The application must be
signed by: (a) the individual, if person is an
individual, (b) the president, vice president, or
other principal officer, if the person is a
corporation, (c) a responsible and duly
authorized member or officer having
knowledge of its affairs, if the person isa
partnership or other unincorporated
organization, or (d) the fiduciary, if the person
is a trust or estate.


rom | S94 Application for Employer Identification Number | ,,,

(Rev. August 1989) (For use by employers and others. Please read the attached instructions ‘OME No. 1545-0008

Department of the Treasury before completing this form.) Please type or print clearly.
Internal Revenue Service preting ) ype or p y Expires 7-31-91

1 Name of applicant (True legal name) (See instructions.)

2 Trade name of business, if different from name in line 1 3° Executor, trustee, “care of name”
4a Mailing address (street address) (room, apt., or suite no.) 5a Address of business. (See instructions.)
4b City, state, and ZIP code 5b City, state, and ZIP code

6 County and state where principal business is located

7 Name of principal officer, grantor, or general partner. (See instructions.) >

8a Type of entity (Check only one box.) (See instructions.) OO Estate Oo Trust
CO IndividuaissN___E CO Plan administratorSsN__i i 1 Partnership
O Remic C Personal service corp. 1 Other corporation (specify) __________ []_ Farmers’ cooperative
O State/local government 0 National guard 1 Federal government/military © Church or church controlled organization
(1 Other nonprofit organization (specify)___________ If nonprofit organization enter GEN (if applicable) ___
1 Other (specify) >
8b Ifa corporation, give name of foreign country (if Foreign country State
applicable) or state in the U.S. where incorporated >
9 Reason for applying (Check only one box) (Changed type of organization (specify) >-
C2 Started new business C1 Purchased going business
O. Hired employees O Created a trust (specify) >.
CO. Created a pension plan (specify type) >-
(Banking purpose (specify) > Other (specify) >

10 Date business started or acquired (Mo., day, year) (See instruction:

) 11 Enter closing month of accounting year. (See instructions.)

12. First date wages or annuities were paid or will be paid (Mo., dey, year) Note: /f applicants is a withholding agent, enter date income will first be paid to

nonresident alien. (Mo., day, year). . . . 2. «1 1 : oe

13 Enter highest number of employees expected in the next 12 months. Note: /fthe applicant does not | Nonagricultural] Agricultural | Household
expect to have any employees during the period, enter"0.".. . 1. ee ee

14 Does the applicant operate more than one place of business?. . . 1 1. ee ee ee ee ee es OD Yes O No

If “Yes,” enter name of business. >
15 Principal activity or service (See instructions.) >

16 Is the principal business activity manufacturing? . . . 1 ee ee ee ee ee ee ee «OF Yes O No
If"Yes,” principal product and raw material used
17 To whom are most of the products or services sold? Please check the appropriate box. Business (wholesale)
1 Public (retail) _ Other (specify) > Ona
18a Has the applicant ever applied for an identification number for this or any other business?, . . . . . . . « » +O Yes 1 No

Note: if “Yes,” please complete lines 18b and 18c.
18b Ifyou checked the “Yes” box in line 18a, give applicant's true name and trade name, if different than name shown on prior application.

True name > Tradename >
18c Enter approximate date, city, and state where the application was filed and the previous employer identification number if known.
Approximate date when filed (Mo., day, year) City and state where filed Previous EIN
Under penalties of perjury, | declare that | have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete. Telephone number (include area code)

Name and title (Please type or print clearly.) D>

Signature > Date >

Note: Do not write below this line. For official use only.
Please leave | S¢°- Ind Class Size Reason for applying
blank >

For Paperwork Reduction Act Notice, see attached instructions. Form SS-4 (Rev. 8-89)




si) Department of the Treasury
Internal Revenue Service

Instructions for Form SS-4

(Rev. August 1989)
Applicati

n for Employer Identification Number

(Section references are to the jnternal Revenue Code unless otherwise noted.)

Paperwork Reduction Act Notice.—We ask
for this information to carry out the Internal
Revenue laws of the United States. We need it
to ensure that taxpayers are complying with
these laws. You are required to give us this
information.

The time needed to complete this form will
vary depending on individual circumstances.
The estimated average time is:

Recordkeeping 5 hrs., 59 min.
Preparing and

sending the form to

IRS... eee 6 min.

If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form more simple,
we would be happy to hear from you. You can
write to the Internal Revenue Service,
Washington, DC 20224, Attention: IRS
Reports Clearance Officer T:FP; or the Office
of Management and Budget, Paperwork
Reduction Project (1545-0003), Washington,
DC 20503.

General Instructions

Purpose.—Use this form to apply for an
employer identification number (EIN). Return
this form to the Internal Revenue Service. You
will receive your EIN in the mail.

Note: The information you provide on this
form will establish your filing requirements.
Who Must File. —You must file this form if
you have not obtained an EIN before and:

(a) You pay wages to one or more
employees;

(b) You are required to have an EIN to use
on any return, statement, or other
document, even if you are not an
employer; or

(c) You are required to withhold taxes on
income, other than wages, paid toa
nonresident alien (individual,
corporation, partnership, etc.). For
example, individuals who file Form
1042, Annual Withholding Tax Return
for U.S. Source Income of Foreign
Persons, to report alimony paid to
nonresident aliens must have EINs.

Individuals who file Schedule C, Profit or

Loss From Business, or Schedule F, Farm
Income and Expenses, of Form 1040, U.S.
Individual Income Tax Return, must use EINs
if they have a Keogh plan or are required to file
excise, employment, or alcohol, tobacco, or
firearms returns.

The following must use EINs even if they do

not have any employees:

e Trusts, except an IRA trust unless the IRA
trust is required to file Form 990-T, Exempt
Organization Business Income Tax Return, to
report unrelated business taxable income or is
filing Form 990-T to obtain a refund of the
credit from a regulated investment company.

@ Estates

@ Partnerships

@ REMICs (Real estate mortgage investment
conduits)

@ Corporations

‘© Nonprofit organizations (churches, clubs,
etc.)

© Farmers’ cooperatives

@ Plan administrators

New Business.—lf you become the new
owner of an existing business, DO NOT use
the EIN of the former owner. If you already
have an EIN, use that number. If you do not
have an EIN, apply for one on this form. If you
become the “owner” of a corporation by
acquiring its stock, use the corporation's EIN.

If you incorporate a sole proprietorship or
form a partnership, you must get a new EIN.
File Only One Form SS-4.—File only one
Form SS-4, regardless of the number of
businesses operated or trade names under
which a business operates. However, each
corporation in an affiliated group must file a
separate application.

If you do not have a number by the time a
return is due, write ‘Applied for’’ and the date
you applied in the space shown for the
number. If you do not have a number by the
time a tax deposit is due, send your payment
to the Internal Revenue Service Center for
your filing area. (See “Where To File” below.)
Make it payable to Internal Revenue Service
and show your name (as shown on Form SS-
4), address, kind of tax, period covered, and
date you applied for an EIN.

For more information about EINs, see Pub.
583, Information for Business Taxpayers.
When To File.—File 4 to 5 weeks before you
will need the number. Make sure you sign and
date the application.

Where To File.—
Ifyour principal business,

office or agency, or legal File with the
residence in the case of an Internal Revenue
individual, is located in: Service Center at:

Florida, Georgia, South Carolina

New Jersey, New York
City and counties of,
Nassau, Rockland, Suffolk,
and Westchester

Atlanta, GA 39901

Holtsville, NY 00501

Connecticut, Maine,
Massachusetts,

New Hampshire,

New York (all other counties),
Rhode Island, Vermont

illinois, lowa, Minnesota
Missouri, Wisconsin

Delaware, District of
Columbia, Maryland,
Pennsylvania, Virginia

indiana, Kentucky,

Michigan, Ohio,
West Virginia

Andover, MA 05501

Kansas City, MO 64999

Philadelphia, PA 19255

Cincinnati, OH 45999

Kansas, New Mexico,
Oklahoma, Texas
Alaska, Arizona, California
(counties of Alpine, Amador,
Butte, Calaveras, Colusa, Contra
Costa, Del Norte, E! Dorado,
Glenn, Humboldt, Lake, Lassen,
Marin, Mendocino, Modoc, Napa,
Nevada, Placer, Plumas,
Sacramento, San Joaquin, Shasta,
Sierra, Siskiyou, Solano, Sonoma,
Sutter, Tehama, Trinity, Yolo, and
Yuba), Colorado, Idaho, Montana,
Nebraska, Nevada, North Dakota,
Oregon, South Dakota, Utah,
Washington, Wyoming
California (all other counties),
Hawaii
Alabama, Arkansas, Louisiana,
Mississippi, North Carolina,
Tennessee

If you have no legal residence, principal place
of business, or principal office or agency in any
Internal Revenue District, file your form with the
Internal Revenue Service Center, Philadelphia,
PA 19255

Specific Instructions

The instructions that follow are for those items
that are not self-explanatory. Enter N/A
(nonapplicable) on the lines that do not apply.
Line 1.—Enter the legal name of the entity
applying for the EIN.

Individuals.—Enter the first name, middle
initial, and last name.

Trusts.—Enter the name of the trust.

Estate of a decedent.—Enter the name of
the estate.

Partnerships.—Enter the legal name of the
partnership as it appears in the partnership
agreement.

Corporations.—Enter the corporate name
as set forth in the corporation charter or other
legal document creating it.

Plan administrators.—Enter the name of
the plan administrator. A plan administrator
that already has an EIN should use that
number and do not apply for another.

Line 2.—Enter the trade name of the
business if different from the legal name.
Note: Use the full legal name entered on line
1 onall tax returns to be filed for the entity.
However, if a trade name is entered on line 2,
use only the name on line _1 or the name on
line 2 ona consistent basis when filing tax
returns.

Line 3.—Trusts enter the name of the
trustee. Estates enter the name of the
executor, administrator, or other fiduciary. If
the entity applying has a designated person to
receive tax information, enter that person's
name as the “care of” person. When entering
names, print or type first name, middle initial,
and last name.

Line 5a and 5b.—If the physical location of
the business is different from the mailing
address (lines 4a and 4b), enter the address of
the physical location on lines 5a and 5b.

Line 7.—Enter the first name, middle initial,
and last name of a principal officer if the
business is a corporation; of a general partner
if a partnership; and of a grantor if a trust.
Line 8a.—Check the box that best describes
the type of entity that is applying for the EIN.
Do not enter N/A. If not specifically
mentioned, check the “other” box and enter
the type of entity.

Austin, TX 73301

Ogden, UT 84201

Fresno, CA 93888

Memphis, TN 37501