Form B - Application For Tax Registration (Withholding, Sales, Use, And Excise Taxes)
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4*991092000*
MAINE REVENUE SERVICES AND DEPARTMENT OF LABOR
FORM
APPLICATION FOR TAX REGISTRATION
B
(WITHHOLDING, SALES, USE, and EXCISE TAXES)
*991092000*
Return Application to: Department of Labor, Central Registration Section, P.O. Box 1057, Augusta, ME 04332-1057
SECTION 1 — TAXPAYER INFORMATION
1. BUSINESS INFORMATION
Legal Name ____________________________________________
Doing Business As _______________________________________________________
Social Security Number ___________________________________
Business Phone Number __________________________________________________
Fed. Employer’ s ID # (FEIN) _______________________________
Street Address of Business Location (Physical Location) _________________________
__________________________________________________
Primary Mailing Address __________________________________
______________________________________
__________________________________________________
2. TYPE OF OWNERSHIP (check appropriate box)
* = Federal Employer ID # required above
Sole Proprietor
Partnership*
Estate*
Association*
C Corporation (Regular)*
Limited Partnership*
Trust*
Other*
S Corporation (Sub “ S” )*
Limited Liability Company*
Non Profit Organization (501(c)(3))*
(attach copy of form 8832)
(attach copy of exemption letter)
Corporation (Non Profit)*
If you marked “ Other” , please explain type of ownership ____________________________________________________________________________________
Corporations — Date Incorporated __________________________________
State of Incorporation _____________________________________________
Limited Partnerships — Date Registered _____________________________
State of Registration ______________________________________________
Limited Liability Co.’ s — Date Registered ____________________________
State of Registration ______________________________________________
3. BUSINESS DESCRIPTION/PRINCIPAL ACTIVITY (for example: Wholesale, Retail, Contractor, Etc.): ________________________________________
4. OWNER INFORMATION (Names of Partners or Officers, Name of Trustee or Personal Representative)
Name & Title ___________________________________________
Name & Title ____________________________________________________________
Social Security Number (required) __________________________
Social Security Number (required) __________________________________________
% of Business Owned ___________
% of Business Owned ___________
Address _______________________________________________
Address ________________________________________________________________
______________________________________________________
_______________________________________________________________________
5. DO YOU OWN OTHER BUSINESSES?
Other Business Name ____________________________________
Other Business Name _____________________________________________________
Fed. Employer’ s ID No. (FEIN) ____________________________
Fed. Employer’ s ID No. (FEIN) ______________________________________________
UC Employer Account No. _________________________________
UC Employer Account No. _________________________________________________
Address _______________________________________________
Address ________________________________________________________________
______________________________________
__________________________________________________
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6. BUSINESS OWNERSHIP INFORMATION
Business Ownership Date
How did you get the business?
What part of the previous owner’ s business or assets did you NOT get? ________________________________
Purchase
Foreclosure Sale
Previous Owner’ s Name ______________________________________________________________________
Merger
Other (describe)
Previous Owner’ s Address ____________________________________________________________________
REQUIRED INFORMATION:
Previous Owner’ s: Sales Tax Registration No.
UC Employer Account No.
Did the previous owner do business in Maine? Yes
No
Did the previous owner have employment in Maine? Yes
No
7. FEDERAL UNEMPLOYMENT TAX
Is your organization subject to the Federal Unemployment Tax? (If unknown, leave blank.)
Yes
No
SECTION 2 — WITHHOLDING TAX
8. REGISTRATION DATE FOR WITHHOLDING TAX: ____________________________
This is the date you began withholding Maine income tax or were required to withhold Maine income tax.
9. ESTIMATED ANNUAL WITHHOLDING TAX LIABILITY
Payment Frequency
Withholding of
Complete Section 3 of Form A to register as an employer with the Department
Semi-Weekly
$18,000 or more per year
of Labor and to file unemployment insurance contributions and employer wage
reports.
Quarterly
less than $18,000 per year
10. WITHHOLDING TAX ACCOUNT ADDRESS
ADDRESS ______________________________________________
ATTENTION: ___________________________________________________________
_______________________________________________________
PHONE NUMBER _______________________________________________________
ALL APPLICANTS MUST COMPLETE SECTION 1. COMPLETE OTHER SECTIONS AS NEEDED.
FORM
*PLEASE SIGN APPLICATION ON REVERSE SIDE*
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