Form De 1ag - Agricultural Employer Account Registration And Update Form - 2016 Page 4
Download a blank fillable Form De 1ag - Agricultural Employer Account Registration And Update Form - 2016 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form De 1ag - Agricultural Employer Account Registration And Update Form - 2016 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4G. CORPORATE OFFICER(S), PARTNERS, OR LLC MEMBER(S), MANAGER(S), AND/OR OFFICER
INFORMATION – Enter name, title, Social Security number (SSN), and California driver license number of each
individual/business entity, as applicable. If an individual/business entity is from a foreign jurisdiction, enter “Foreign”
in the SSN/FEIN box. Select “Add” to add, “Chg.” to change, and “Del.” to delete an individual/entity on the employer
account.
H. LEGAL NAME OF ORGANIZATION – Enter the business legal name. For Corporation/LLC/LLP/LP, enter the name
exactly as it appears on your offi cial registration documents. If you are registered with the California Secretary of State
(SOS) and do not have the business name as it was registered, log on to the SOS website at
to
obtain the information.
I.
DOING BUSINESS AS (DBA) (If applicable) – Enter business name known to the public, if different from the legal name.
J. FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) – Enter the Federal Employer Identifi cation Number
(FEIN) assigned by the Internal Revenue Service (IRS). If not assigned, enter “Applied For.”
K. DATE OWNERSHIP BEGAN – Enter the date (MM/DD/YYYY) new ownership began operating.
L. STATE OR PROVINCE OF INCORPORATION/ORGANIZATION – Enter the state or province where the business is
incorporated or organized.
M. CALIFORNIA SECRETARY OF STATE ENTITY NUMBER – Enter the California Corporate/LLC/LLP/LP entity
number. If you are registered with the California Secretary of State (SOS) and do not have the entity number, log on to
the SOS website at
to obtain the information.
N. PHYSICAL BUSINESS LOCATION – Enter the California street address (PO Box or Private Mail Box will not be
accepted) and phone number where the business is physically conducted. If you have multiple California locations,
please attach a listing of the physical business addresses.
O. MAILING ADDRESS – Enter the mailing address where the EDD correspondence and forms should be sent (PO
Box or Private Mail Box is acceptable). If the physical and mailing addresses are the same, check the box “Same as
above.” Provide a daytime phone number.
P. E-MAIL – Enter a valid e-mail address. Check the box if you would like to receive registration information via e-mail.
Q. INDUSTRY ACTIVITY – Describe in detail the primary crops or agricultural services that the business performs,
such as apple grower, farm labor contractor, veterinary services, etc. This information is used to assign an Industrial
Classifi cation Code to your business. For more information on industry coding or the North American Industrial
Classifi cation System (NAICS), visit the website at
R. CONTACT PERSON – Enter the name, daytime phone number, e-mail address, relation, and address of the person
authorized by the ownership to provide the EDD with information needed to maintain the accuracy of your employer
account. If the contact person is an outside accountant, agent, or tax representative, complete and submit a Power of
Attorney (POA) Declaration
(DE
48).
S. DECLARATION – This declaration must be signed by an individual having the authority to sign on behalf of the
business under penalty of perjury.
Allow up to 14 days for your paper request to be processed. You will receive your Employer Account Number by US Postal
Service. To obtain an Employer Account Number faster, register online at The
California Employer’s Guide
(DE
44) is available at
to help you understand your
tax withholding and fi ling responsibilities.
Need more help or information?
If you have questions regarding this form, the registration process, or to determine whether your business is required
to register, visit the EDD website at
or contact the
Taxpayer Assistance Center at 888-745-3886 or TTY (nonverbal) 800-547-9565.
●
The EDD provides seminar and other educational opportunities for taxpayers to learn how to report employees’
wages, pay taxes, and to help avoid errors and unnecessary billings. Register for a seminar near you at
or call 888-745-3886 for more information.
●
The EDD website
offers additional information, forms, publications, and information sheets to
assist you.
DE 1AG Rev. 12 (2-16) (INTERNET)
Page 4 of 4
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form De 1p - Employers Depositing Only Personal Income Tax Withholding Registration And Update Form - 2016
Legal
Form De 1hw - Employers Of Household Workers Registration And Update Form - California Employment Development Department
Legal
Form De 1gs - Governmental Organizations, Public Schools, And Indian Tribes Registration And Update Form - 2015
Legal
Related Categories
Parent category: Legal