Form Fr-500 - Combined Business Tax Registration Application Page 3
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4COMPLETE THIS PART IF ANY OF YOUR EMPLOYEES WORK IN THE DISTRICT OF COLUMBIA
PART VI — Unemployment Compensation Tax Registration
IMPORTANT: Although some information has already been requested in Part I, this form must be completed in its
entirety by all applicants who have employees working in the District. Part VI will be processed separately from Parts I
through V. For more information call (202) 698-5124 or (202) 698-5126 or (202) 698-5127.
1. Federal Employer
2. Previously assigned unemployment
–
Identification Number
insurance number (if applicable)
–
Reason for applying:
3. Type of ownership (check one)
New Business
Additional location
Sole Proprietor
Household/domestic
Merger (attach merger
Purchased existing
Partnership
Limited liability company
agreement)
business
Joint Venture
Limited liability partnership
Household/domestic
Other (specify)
Corporation
Other (specify)
Name Change
________________________
___________________________
(if a corporation attach corporation amendment)
If incorporated, enter:
Change of Entity
State __________________ Date ___________________
Reorganization
Mo.
Day
Yr.
4. Describe in detail your business activity and/or major source of sales that generate sales and use tax; specify the product manufactured
and/or sold, or the type of service performed. (Omission of this information may delay the determination of your status.)
5. Entity name
6.Trade name (if different from line 5)
7. Street address of D.C. business or D.C. worksite
8.Mailing address for ALL returns
(P.O. Box is not acceptable)
10. Owner, officer, or agent responsible for reporting and remitting
9. Electronic Means of Communication
unemployment taxes:
(Leave blank if not applicable)
Local Voice Number
______________________________
Name __________________________________________________
Local Fax Number
______________________________
Title ___________________________________________________
Main Office Voice Number ______________________________
Main Office Fax Number ______________________________
Voice No. ______________________________________________
E-mail Address
______________________________
Fax No. ________________________________________________
Website Address
______________________________
11. List proprietor, partners, or principal officers
Name and Title
Address
Social Security Number
— COMPLETE REVERSE SIDE —
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