Form SS 4 (Rev. December 2017)


1 OMB No. 1545-0003 Application for Employer Identification Number Form SS-4 (For use by employers, corporations, partnerships, trusts, estates, churches, EIN government agencies, Indian tribal entities, certain individuals, and others.) (Rev. December 2017) ▶ Go to for instructions and the latest information. Department of the Treasury ▶ ▶ Keep a copy for your records. See separate instructions for each line. Internal Revenue Service 1 Legal name of entity (or individual) for whom the EIN is being requested Trade name of business (if different from name on line 1) 3 Executor, administrator, trustee, “care of” name 2 Mailing address (room, apt., suite no. and street, or P.O. box) 4a Street address (if different) (Do not enter a P.O. box.) 5a City, state, and ZIP code (if foreign, see instructions) City, state, and ZIP code (if foreign, see instructions) 4b 5b County and state where principal business is located 6 Type or print clearly. Name of responsible party 7b SSN, ITIN, or EIN 7a of number the enter “Yes,” is If 8a 8b for 8a Is this application a limited liability company (LLC) ▶ LLC members . . . . . . . . (or a foreign equivalent)? . . . . . . No Yes If 8a is “Yes,” was the LLC organized in the United States? . . . . . . . . . . . . . . . . . . 8c No Yes (check only one box). . If 8a is “Yes,” see the instructions for the correct box to check. Type of entity Caution 9a Sole proprietor (SSN) Estate (SSN of decedent) Partnership Plan administrator (TIN) ▶ Trust (TIN of grantor) Corporation (enter form number to be filed) Personal service corporation Military/National Guard State/local government Farmers’ cooperative Federal government Church or church-controlled organization ▶ Indian tribal governments/enterprises REMIC Other nonprofit organization (specify) ▶ ▶ Other (specify) Group Exemption Number (GEN) if any 9b If a corporation, name the state or foreign country (if State Foreign country applicable) where incorporated ▶ Reason for applying (check only one box) Banking purpose (specify purpose) 10 ▶ ▶ Started new business (specify type) Changed type of organization (specify new type) Purchased going business ▶ Created a trust (specify type) Hired employees (Check the box and see line 13.) ▶ Compliance with IRS withholding regulations Created a pension plan (specify type) ▶ Other (specify) 12 11 Closing month of accounting year Date business started or acquired (month, day, year). See instructions. 14 If you expect your employment tax liability to be $1,000 or want to file Form 944 and less in a full calendar year 13 Highest number of employees expected in the next 12 months (enter -0- if none). annually instead of Forms 941 quarterly, check here. If no employees expected, skip line 14. (Your employment tax liability generally will be $1,000 or less if you expect to pay $4,000 or less in total wages.) Other Household Agricultural If you do not check this box, you must file Form 941 for every quarter. First date wages or annuities were paid (month, day, year). Note : If applicant is a withholding agent, enter date income will first be paid to 15 ▶ . . . . . . . . . . . . . . . . . nonresident alien (month, day, year) 16 Check box that best describes the principal activity of your business. Health care & social assistance Wholesale-agent/broker one Rental & leasing Accommodation & food service Wholesale-other Retail Construction Transportation & warehousing ▶ Real estate Manufacturing Other (specify) Finance & insurance Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided. 17 18 Has the applicant entity shown on line 1 ever applied for and received an EIN? Yes No ▶ If “Yes,” write previous EIN here if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form. Complete this section only Designee’s telephone number (include area code) Third Designee’s name Party Designee Designee’s fax number (include area code) Address and ZIP code Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete. Applicant’s telephone number (include area code) ▶ Name and title (type or print clearly) Applicant’s fax number (include area code) ▶ ▶ Signature Date Form SS-4 (Rev. 12-2017) For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 16055N

2 Form SS-4 (Rev. 12-2017) Page 2 Do I Need an EIN? File Form SS-4 if the applicant entity does not already have an EIN but is required to show an EIN on any return, statement, 1 or other document. See also the separate instructions for each line on Form SS-4. AND... THEN... IF the applicant... Started a new business Complete lines 1, 2, 4a–8a, 8b–c (if applicable), 9a, Does not currently have (nor expect to have) 9b (if applicable), and 10–14 and 16–18. employees Does not already have an EIN Hired (or will hire) employees, Complete lines 1, 2, 4a–6, 7a–b (if applicable), 8a, 8b–c (if applicable), 9a, 9b (if applicable), 10–18. including household employees Complete lines 1–5b, 7a–b (if applicable), 8a, 8b–c Opened a bank account Needs an EIN for banking purposes only (if applicable), 9a, 9b (if applicable), 10, and 18. Either the legal character of the organization or its Changed type of organization Complete lines 1–18 (as applicable). ownership changed (for example, you incorporate a 2 sole proprietorship or form a partnership) 3 Does not already have an EIN Complete lines 1–18 (as applicable). Purchased a going business The trust is other than a grantor trust or an IRA Created a trust Complete lines 1–18 (as applicable). 4 trust Complete lines 1, 3, 4a–5b, 9a, 10, and 18. Created a pension plan as a Needs an EIN for reporting purposes 5 plan administrator Complete lines 1–5b, 7a–b (SSN or ITIN optional), Is a foreign person needing an Needs an EIN to complete a Form W-8 (other than 8a, 8b–c (if applicable), 9a, 9b (if applicable), 10, EIN to comply with IRS Form W-8ECI), avoid withholding on portfolio assets, 6 withholding regulations and 18. or claim tax treaty benefits Needs an EIN to report estate income on Form 1041 Complete lines 1–6, 9a, 10–12, 13–17 (if applicable), Is administering an estate and 18. Is a withholding agent for Complete lines 1, 2, 3 (if applicable), 4a–5b, 7a–b (if Is an agent, broker, fiduciary, manager, tenant, or applicable), 8a, 8b–c (if applicable), 9a, 9b (if spouse who is required to file Form 1042, Annual taxes on non-wage income Withholding Tax Return for U.S. Source Income of paid to an alien (i.e., applicable), 10, and 18. Foreign Persons individual, corporation, or partnership, etc.) Is a state or local agency Serves as a tax reporting agent for public assistance Complete lines 1, 2, 4a–5b, 9a, 10, and 18. 7 recipients under Rev. Proc. 80-4, 1980-1 C.B. 581 Needs an EIN to file Form 8832, Classification Is a single-member LLC (or Complete lines 1–18 (as applicable). similar single-member entity) Election, for filing employment tax returns and 8 excise tax returns, or for state reporting purposes , or is a foreign-owned U.S. disregarded entity and needs an EIN to file Form 5472, Information Return of a 25% Foreign-Owned U.S. Corporation or a Foreign Corporation Engaged in a U.S. Trade or Business (Under Sections 6038A and 6038C of the Internal Revenue Code) Needs an EIN to file Form 2553, Election by a Small Is an S corporation Complete lines 1–18 (as applicable). 9 Business Corporation 1 For example, a sole proprietorship or self-employed farmer who establishes a qualified retirement plan, or is required to file excise, employment, alcohol, tobacco, or firearms returns, must have an EIN. A partnership, corporation, REMIC (real estate mortgage investment conduit), nonprofit organization (church, club, etc.), or farmers’ cooperative must use an EIN for any tax-related purpose even if the entity does not have employees. 2 However, do not apply for a new EIN if the existing entity only (a) changed its business name, (b) elected on Form 8832 to change the way it is taxed (or is covered by the default rules), or (c) terminated its partnership status because at least 50% of the total interests in partnership capital and profits were sold or exchanged within a 12- month period. The EIN of the terminated partnership should continue to be used. See Regulations section 301.6109-1(d)(2)(iii). 3 Do not use the EIN of the prior business unless you became the “owner” of a corporation by acquiring its stock. 4 However, grantor trusts that do not file using Optional Method 1 and IRA trusts that are required to file Form 990-T, Exempt Organization Business Income Tax Return, must have an EIN. For more information on grantor trusts, see the Instructions for Form 1041. 5 A plan administrator is the person or group of persons specified as the administrator by the instrument under which the plan is operated. 6 Entities applying to be a Qualified Intermediary (QI) need a QI-EIN even if they already have an EIN. See Rev. Proc. 2000-12. 7 State or local agencies may need an EIN for other reasons, for example, hired employees. See also on page 4 of the instructions. Note : Household employer 8 See Disregarded entities on page 4 of the instructions for details on completing Form SS-4 for an LLC. 9 An existing corporation that is electing or revoking S corporation status should use its previously-assigned EIN.

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