Form Fr-500 - Combined Registration Application For Business

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COMBINED REGISTRATION APPLICATION FOR
GOVERNMENT OF THE DISTRICT OF COLUMBIA
FR-500
BUSINESS DC TAXES/FEES/ASSESSMENTS
OFFICE OF TAX AND REVENUE
PART I — General Information
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1a. Federal Employer Identification Number
2. NAICS Business Code
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1b. Social Security Number
3. Reason for application: (please check)
4. Legal form of business (please check):
❏ New business
❏ Employment of household/domestic help ❏ Sole Proprietor
❏ Limited Partnership
❏ Additional location
❏ Address change
❏ Limited Liability Company
❏ Government
❏ Purchased existing business
❏ Merger (attach merger agreement)
❏ General Partnership
❏ Joint Venture
❏ Name change
❏ Other (describe on an attachment)
❏ Limited Liability Partnership ❏ Other (specify)
(if a corporation, attach corporation amendment) ❏ Heating oil company
❏ Corporation
❏ Legal form change
❏ Utility company
Mandatory: If incorporated, enter state and date of incorporation.
❏ Street and Mobile Food Services Vendor
State _________________ Mo. _____ Day _____ Yr _____otherwise go to Line 5.
5. Business Name (Individual, Partnership, Corporation)
6. Trade Name (if different from Line 5)
7. Business Address (PO Box is not acceptable unless located in a Rural Area)
8. Mailing Address
8a. Email Address
8b. Website Address
9. Local Business Phone No. 10. Main Office Phone No.
10(a). Fax No.
11. Date present business began or is
expected to begin in DC
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)
(
)
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)
Mo. ________ Day ________ Year ________
12. If previously registered with the DC, please provide:
Former Entity Name __________________________________________ Business Tax Registration Number __________________________________
Former Trade Name ___________________________________________ Name of Former Owner(s) _________________________________________
13. NAME, TITLE, HOME ADDRESS, SOCIAL SECURITY NUMBER OF PROPRIETOR, PARTNERS OR PRINCIPAL OFFICERS
Name and Title
Home Address
Zip Code
Social Security Number
E-mail Address
Name and Title
Home Address
Zip Code
Social Security Number
E-mail Address
Name and Title
Home Address
Zip Code
Social Security Number
E-mail Address
PART II — Franchise Tax Registration
14. Indicate your profession, principal business activity or service (for example, retail grocery, wholesale auto parts, barber shop, doctor, contractor, etc.)
15. Do you or will you have an office, warehouse, or other place of business in DC, or a representative
with a DC location?
❏ Yes ❏ No
16. Do you or will you have merchandise stored in a public or private warehouse in DC?
❏ Yes ❏ No
17. Do you or will you perform in DC personal services (medical, accounting, consulting), or other services such as
electrical, heating, construction, etc., or installations or repairs of any type?
❏ Yes ❏ No
18. Do you or will you generate any business related income from DC sources?
❏ Yes ❏ No
19. Do you or will you have rental property in DC? ❏ Yes ❏ No
20. Date converted or expected to be converted to rental property ____/____/____
21. Date on which your taxable year ends:
Month ________ Day ________ Year ________ (❏ Calendar or ❏ Fiscal)
22. Describe fully ALL your current or expected business activities and/or major type of services performed within DC.
(Attach separate sheet if necessary.)
(Rev. 05/15 )
— INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED AND WILL BE RETURNED —

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