Ss-4 Application for Employer Identification Number
Form oe EIN
(Rev. April 1991) {For use by employers and 0 and others. Piease read the attached instructions [ome No 1545-0003
Department of the Treasury OMB No. 1545-0003
Internal Revenue Service before completing this form.) Expires 4-30-94
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
2
6
E 4a Mailing address (street address) (room, apt., or suite no.) 5a Address of business (See instructions.)
: ‘4b City, state, and ZIP code ‘Sb City, state, and ZIP code
j 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)  [(] Estate OO Trust
Ol individual SSN Plan administrator SSN __i «CL Partnership
CO REmic Personal service corp. [1] Other corporation (specify) ______________ [1] Farmers’ cooperative
D State/ocal government ] National guard 1D Federat govemment/military [1 Church or church controlled organization
(1 Other nonprofit organization (specify) ____________If nonprofit organization enter GEN {if applicable)
Other (specify) >
‘8b if a 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) >
CO Started new business C1 Purchased going business
(2 Hired employees CO Created a trust (specify) >
( Created a pension plan (specify type) >
LJ Banking purpose (specify) > C1 Other (specify) >
10 Date business started or acquired (Mo., day, year) (See instructions.) 41 Enter closing month of accounting year. (See instructions.)

12 First date wages or annuities were paid or will be paid (o., dey, year). Note: /f applicant is isa pinnolaing agent, enter date income will first
be paid to nonresident alien. (Mo., day, year) - - hone

43. Enter highest number of employees expected in the next 12 months. Note: /f the applicant Nonagricuttural | Agricultural | Household
does not expect to have any employees during the period, enter “0.” >
74 _ Principal activity (Gee instructions) >

15 Is the principal business activity manufacturing? 2 2... ee ee ee ee Des =O No
if “Yes,” principal product and raw material used >
16 To whom are most of the products or services sold? Please check the appropriate box. 1 Business (wholesale)
(1 Pubiic (retail) (1 Other (specify) > O Na
47a Has the applicant ever applied for an identification number for this or any other business?. . . . . . . . CD Yes OO No

Note: if “Yes,” please complete lines 17b and 17c.
47 If you checked the “Yes” box in line 17a, give applicant's true name and trade name, if different than name shown on prior application.

True name > Trade name >
17¢ 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, itis true, correct, and complete Telephone number (include area code)

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

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. Cat. No. 16055N Form SS-4 (Rev. 4-91)


Form SS-4 (Rev. 4-91)

Page 2

General Instructions
(Section references are to the intemal
Revenue Code unless otherwise noted.)
Paperwork Reduction Act Notice.—We ask
for the information on this form to carry out
the Internal Revenue laws of the United
States. You are required to give us this
information. We need it to ensure that you are
complying with these laws and to allow us to
figure and collect the right amount of tax.
The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time
is:

Recordkeeping. 7 min.
Learning about the

law or the form 21 min.
Preparing the form 42 min.
Copying, assembling, and

sending the form to IRS . 20 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 both the Internal Revenue
Service, Washington, DC 20224, Attention:
IRS Reports Clearance Officer, T:FP; and the
Office of Management and Budget,
Paperwork Reduction Project (1545-0003),
Washington, DG 20503. DO NOT send the
tax form to either of these offices. Instead,
see Where To Apply.

Purpose.—Use Form SS-4 to apply for an
employer identification number (EIN). 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

@ You pay wages to one or more employees.
You are required to have an EIN to use on
any return, statement, or other document,
even if you are not an employer.

© You are required to withhold taxes on
income, other than wages, paid to a
nonresident alien (individual, corporation,
partnership, etc.). For example, individuals
who file Form 1042, Annual Withholding Tax
Retum 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, Profit or
Loss From Farming, of Form 1040, U.S.
Individual Income Tax Retum, must use EINs
if they have a Keogh plan or are required to
file excise, employment, or alcohol, tobacco,
or firearms retums.

The following must use EINs even if they
do not have any employees:
© Trusts, except an IRA trust, unless the IRA
trust is required to file Form 990-T, Exempt
Organization Business Income Tax’Retum, 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
e Nonprofi organizations (churches, clubs,

ic.)

© Farmers’ cooperatives
@ Plan administrators

New Business.—if 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 already have an EIN, you may need
to get a new one if either the organization or
‘ownership of your business changes. If you
incorporate a sole proprietorship or form a
partnership, you must get a new EIN.
However, DO NOT apply for a new EIN if you
change only the name of your business.

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 an EIN by the time a
retum is due, write “Applied for” and the date
you applied in the space shown for the
number. DO NOT show your social security
number as an EIN on returns.

If you do not have an EIN by the time a tax
deposit is due, send your payment to the
Internal Revenue service center for your filing
area. (See Where To Apply below.) Make
your check or money order 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, Taxpayers Starting a Business.

How To Apply.—You can apply for an EIN
either by mail or by telephone. You can get
an EIN immediately by calling the Tele-TIN
phone number for the service center for your
state, or you can send the completed Form
‘SS-4 directly to the service center to receive
your EIN in the mail.

Application by Tele-TIN.—The Tele-TIN
program is designed to assign EiNs by
telephone. Under this program, you can
receive your EIN over the telephone and use
it immediately to file a return or make a
payment.

To receive an EIN by phone, complete Form
‘SS-4, then call the Tele-TIN phone number
listed for your state under Where To Apply.
The person making the call must be
authorized to sign the form (see Signature
block on page 3).

An IRS representative will use the
information from the Form SS-4 to establish
your account and assign you an EIN. Write
the number you are given on the upper right-
hand comer of the form, sign and date it, and
promptly mail it to the Tele-TIN Unit at the
service center address for your state.

Application by mail.—Complete Form SS-4
at least 4 to 5 weeks before you will need an
EIN. Sign and date the application and mail it
to the service center address for your state.
You will receive your EIN in the mail in
approximately 4 weeks.

Note: The Tele-TIN phone numbers listed
below will involve a long-distance charge to
callers outside of the local calling area, and
should only be used to apply for an EIN. Use
1-800-829-1040 to ask about an application
by mail.
Where To Apply.—

Call the Tele-TIN
if your principal business, number

phone
office or agency, or legal shown or file with
residence in the case of an the Internal Revenue

individual, is, located in: service center at:
Florida, Georgia, Attanta, GA 39901
South Garolina (404) 455-2360
New Jersey, New York

City and counties of Holtsville, NY 00501
Nassau, Rockland, (616) 447-4955
Suffolk, and Westchester

New York

counties), Connecticut,
Maine, Massachusetts,
New Hampshire, Rhode
Island, Vermont

ilinois, lowa, Minnesota,
Missouri, Wisconsin
Delaware, District of
Columbia, Maryland,
Pennsylvania, Virginia
indiana, Kentucky,
Michigan, Ohio, West

‘Andover, MA 05501
(508) 474-9717

Kansas City, MO 64999
(816) 926-5999

Philadelphia, PA 19255
(215)

961-3980

Cincinnati, OH 45999
(606)

Vignes 292-5467
Kangas, New Mexico, ‘Austin, TX 73901
Oklahoma, Texas (612) 462-7845
Alaska, Arizona, California

counties of Alpine, Amador,

jutte, Calaveras, Colusa, Contra
Costa, Del Norte, Et Dorado,
Glenn, Humboldt, Lake, Lassen,
Marin, Mendocing, Modoc,
Napa, Nevada, Placer, Plumas, 1, UT 84201
Sacramento, San Joaquin, Cen tas

Shasta, Sierra, Sih, Solano,
Sonoma, Sutter, Tehama, Trinity,
Yl, ana Yubs}, Golerado.
Idaho, Montana, Nebraska,

Washington, Wyoming

California (all other
counties), Hawaii

Fresno, CA 93888
(209) 456-5900

Memphis, TN 37501
(901) 365-5970

SSID
North Carolina, Tennessee

if you have no jegal 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 or call (215)
961-3980.

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 who
already has an EIN should use that number.
Line 2.—Enter the trade name of the
business if different from the egal name.
Note: Use the full legal name entered on line
7 on all tax retums 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 consistently when filing tax retums.
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. Print or type the first
name, middle initial, and last name.

Lines 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.



Form SS-4 (Rev. 4-91)

Page 3

Line 7.—Enter the first name, midale 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.
if not specifically mentioned, check the
“other” box and enter the type of entity. Do
not enter N/A.

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
retums. 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 administrator’s SSN in the space
provided.

New withhoiding agent.—If 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 alll prior
tax years,

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

3. Which has one class of residual interests
{and alt 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 alt 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
880E(e) will be made available.

For more information about REMICs see
the Instructions for Form 1066, U. S. Real
Estate Mortgage investment Conduit Income
Tax Return.

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(f) 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.

4. The employee-owners own 10 percent of
the fair market vaiue 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
1441-47.

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 in a
group exemption letter under Revenue
Procedure 80-27, 1980-1 C.B. 677, 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 on line 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
Jast 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.—Y our tax year generally will be
a calendar year.

Partnerships.—Partnerships generally
‘should conform to the tax year of either (1) its
majority partners; (2) its principal partners; (3)
the tax year that results in the least aggregate
deferral of income {see Temporary
Regulations section 1.706-17); or (4) some
other tax year, if (a) a business purpose is
established for the fiscal year, or (b) the fiscal
year is a “grandfather” year, or (c) an election
is made under section 444 to have a fiscal
year. (See the Instructions for Form 1085,
U.S. Partnership Retum 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 tine 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 to a
nonresident alien. This also applies to
individuats who are required to file Form 1042
to report alimony paid to a nonresident alien.
Line 14.—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
normaily performed (for example, general
contractor for residential buildings, electrical
subcontractor, etc.).

Trade.—Specify the type of sales and the
principal {ine 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: (1) the individual, if the person is
an individual, (2) the president, vice president,
or other principal officer, if the person is a
corporation, (3) a responsible and duly
authorized member or officer having
knowledge of its affairs, if the person is a
partnership or other unincorporated
organization, or (4) the fiduciary, if the person
is a trust or estate.

*U.S. Government Printing Office: 1991 — 623-733/40128