Employer Tax Form Packet (Page 3 of 9) in pdf

SS-4

Application for Employer Identification Number

OMB No. 1545-0003

Form

EIN

(For use by employers, corporations, partnerships, trusts, estates, churches,

(Rev. January 2010)

government agencies, Indian tribal entities, certain individuals, and others.)

Department of the Treasury

See separate instructions for each line.

Keep a copy for your records.

Internal Revenue Service

Legal name of entity (or individual) for whom the EIN is being requested

Employer Name

Trade name of business (if different from name on line 1)

Executor, administrator, trustee, “care of” name

Public Partnerships, LLC

Mailing address (room, apt., suite no. and street, or P.O. box)

Street address (if different) (Do not enter a P.O. box.)

1 Cabot Rd Ste 102

Employer Street Address

City, state, and ZIP code (if foreign, see instructions)

Medford, MA 02155

Employer city, state, and ZIP

County and state where principal business is located

Name of responsible party

SSN, ITIN, or EIN

Employer Name

Employer SSN

Is this application for a limited liability company (LLC) (or

If 8a is “Yes,” enter the number of

Yes

a foreign equivalent)?

LLC members

Yes

If 8a is “Yes,” was the LLC organized in the United States?

Type of entity (check only one box). Caution. If 8a is “Yes,” see the instructions for the correct box to check.

Sole proprietor (SSN)

Estate (SSN of decedent)

Partnership

Plan administrator (TIN)

Corporation (enter form number to be filed)

Trust (TIN of grantor)

Personal service corporation

National Guard

State/local government

Church or church-controlled organization

Farmers’ cooperative

Federal government/military

Other nonprofit organization (specify)

REMIC

Indian tribal governments/enterprises

HHCSR Using Fiscal/Employer Agent

Other (specify)

Group Exemption Number (GEN) if any

If a corporation, name the state or foreign country

State

Foreign country

(if applicable) where incorporated

Reason for applying (check only one box)

Banking purpose (specify purpose)

Started new business (specify type)

Changed type of organization (specify new type)

Purchased going business

Hired employees (Check the box and see line 13.)

Created a trust (specify type)

Compliance with IRS withholding regulations

Created a pension plan (specify type)

HHCSR Using Fiscal/Employer Agent

Other (specify)

Date business started or acquired (month, day, year). See instructions.

Closing month of accounting year

December

If you expect your employment tax liability to be $1,000

Highest number of employees expected in the next 12 months (enter -0- if none).

or less in a full calendar year and want to file Form 944

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

Agricultural

Household

Other

wages.) 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

nonresident alien (month, day, year)

Check one box that best describes the principal activity of your business.

Health care & social assistance

Wholesale-agent/broker

Accommodation & food service

Retail

Construction

Rental & leasing

Transportation & warehousing

Wholesale-other

Finance & insurance

Real estate

Manufacturing

Other (specify)

HHCSR Using Fiscal/Employer Agent

Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.

HHCSR Using Fiscal/Employer Agent

Has the applicant entity shown on line 1 ever applied for and received an EIN?

Yes

If “Yes,” write previous EIN here

Complete this section only if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form.

Designee’s name

Designee’s telephone number (include area code)

Third

Kaitlyn Milligan, Jared Enders, Michael McConville

(

617

)

336-2949

Party

Designee

Address and ZIP code

Designee’s fax number (include area code)

c/o Public Partnerships LLC 1 Cabot Rd Ste 102 Medford MA 02155

(

866

)

260-6260

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)

Employer Name

(

Emp

)

Phone #

Name and title (type or print clearly)

Applicant’s fax number (include area code)

(

)

Signature

Date