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ran $S-4 Application for Employer Identification Number

(Re Noverbe 1985) Fee ee aS ete a) ee ee
Department of the Treasury P pleting ., Expires 8-31-88
Internal Revenue Service For Paperwork Reduction Act Notice, see separate instructions.
1 “Name (True name. See instructions.) 2 Social security no., if sole proprietor | 3 Ending month of accounting year
4 Trade name of business if different from item 1 5 General partner's name, if partnership; principal officer's name, if corporation; or

grantor's name, if trust

6 Address of principal place of business (Number and street) 7 Mailing address, if different
8 City, state, and ZIP code 9 City, state, and ZIP code
10 Type of organization  [] Individual [] Trust © [] Partnership [[]_Planadmmistrator 11 County of principal business location
Other
1 Governmental Nonprofit organization 1 Corporation _11_Gpecify)
12 Reason for applying T3 Acquisition or starting date (Mo., day, year).
Started new Purchased Other See instructions.
business C1 _going business C1 Gpecity)
TS First date wages or annuities were paid or
14 Nature of principal activity (See instructions.) Fipy date wages of annuities were p
16 Peak number of employees Nonagricultural Agricultural Household 17 Does the applicant operate more than
expected in the next 12 months ‘one place of business?
(ifnoney enter “0") > Cres [] No
18 Most of the products or services are sold to whom? 19 nature of business is manufacturing, state
Business ‘General Other principal product and raw material used.
C1 establishments (wholesale) C1 public (retail) _ [)_ (specify) ON/A

20. Has the applicant ever applied for an identification number for this,
orany other business? [] yes [] No

If “Yes,"” enter name and trade name. Also enter approx. date, city, and
state where the application was filed and previous number if known.

Under penalties of perjury, ! declare that I have examined this application, and to the best of my knowledge and belief its true, correct, and complete. | Telephone number (include area code)

‘Signature and Title > Date >

Please leave Geo. Ind. Class Size Reas. for appl.

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Form 4 Application for Employer Identification Number
(Rev. November 1985) th (For use by employers and others Please read m) OMB No. 1545-0003
Department of the Treasury © Separate instructions before completing this form. Expires 8-31-88
Internal Revenue Service For Paperwork Reduction Act Notice, see separate instructions.
1 Name (True name. See instructions.) 2 Social security no., ifsole proprietor | 3. Ending month of acccunting vear
4 Trade name of business if different from item 1 5 General partner's name, if partnership; principal officer's name. if corporation; or
grantor's name, if trust
6 Address of principa: piace of business (Number and street) 7 Mailing address, if different
8 City, state, and ZIP code 9 City, state, and ZIP code
10 Type of organization  [] Individual [] Trust [J Partnership []_Planadministrator 11 County of principal business location
ther
1 Governmental T1_Nonprofit organization 1 Corporation _[)_ (Specify)
12 Reason for applying 13 Acquisition or starting date (Mo., day, year).
Started new Purchased Other See instructions.
O1_ business L1_going business O1_ Gpecify
f : 15 First date wages or annuities were paid or
14 Nature of principal activity (See instructions.) will be paid (Mo., day, year).
16 Peak number of employees Nonagricuttural ‘Agricultural Household 17 Does the applicant operate more than
expected in the next 12 months one place of business?
(if none, enter 0") > DvYes 1 No
18 Most of the products or services are sold to whom? 19 If nature of business is manufacturing, state
Business ‘General Other Principal product and raw material used,
1 _ establishments (wholesale) 1 public(retaity [1 (specify) N/A

20° Has the applicant ever applied for an identification number for this
orany other business? [7] yes [] No
f"Yes,"" enter name and trade name. Also enter approx. date. city, and
state where the application was filed and previous number if known. Pe

Under penalties of penury. | declare that have examined this application, and to the best of my knowledge and belief tis true, correct, and complete. | Telephone number (include area code)
Signature and Title > Date >

Please leave Geo. ind. Class Size Reas. for appl.

blank > Part Il