Form 301 - Application To Register For North Dakota Income Tax Withholding Form

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Office of State Tax Commissioner
Form
Application To Register For North Dakota Income Tax Withholding
G06
301
Please enter your assigned federal employer identification number (FEIN) below. The suffix will be assigned by this office.
Federal employer identification number*
Suffix
1.
(This 11-digit number will serve as your State ID No.)
Business name / Trade name
2.
Legal name - if different from name on line 2
3.
Telephone number
4.
Mailing address
5.
City
State
Zip Code
6.
7.
Type of entity
(Check one)
Sole
Corporation
Partnership
Other
Government
Limited
S Corp
Proprietorship
liability co.
I
C
P
O
G
L
S
8.
Enter date on which North Dakota income tax withholding began or will begin.
Month
Day
Year
9.
If principal place of business is other than North Dakota, list name and address of home office
Phone number
Contact person
10.
Principal activity of business
Date business started operating in North Dakota
Month
Day
Year
11.
If business is temporary, give an approximate period of time business will have activity in North Dakota
Month
Day
Year
Month
Day
Year
through
12.
Provide an estimate of the number of employees in North Dakota and the total wages to be paid to them for the current year.
Number of employees
Wages
The application must be signed as follows: If a sole proprietorship, the individual who owns the business must sign. If a partnership, a general
partner must sign. If a corporation, two of the following individuals must sign: president, vice president, secretary or treasurer. If a limited liability
company, a governor or manager must sign.
Printed Name
Signature
Title
Social Security Number
Home address
Printed Name (2nd name if corporation)
Signature
Title
Social Security Number
Home address
(Don't forget to sign the application before submitting it to the ND Office of State Tax Commissioner)
28224

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