Form Fr-500 - Combined Registration Application For Business Page 2

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PART III — Employer’s DC Withholding Tax Registration
23. Estimated total number of employees __________
24. Number of DC resident employees subject to DC
Withholding Tax: _______________
25a. Date when you began to employ DC resident(s) ____/____/____
26. Estimate of amount of DC tax to be withheld monthly from
MM DD YYYY
DC resident employees:
25b. Date when you began or when you expect to begin
27. Will you have employee(s) working in DC?
to withhold DC tax from resident employees ____/____/____
MM DD YYYY
28. Withholding from retirement accounts or plans
Yes
No
PART IV — Sales and Use Tax Registration
29. Check applicable box(es) below
Reporting Sales Tax on retail sales or rentals.
Reporting Use Tax on items purchased tax free inside/outside DC
Purchasing in DC items for resale outside DC (Attach photocopy of state/county sales tax registration.)
Purchasing in DC cigarettes for resale outside DC (Attach photocopy of state/county cigarette/tobacco license.)
Making no taxable sales and tax is paid to vendors on all taxable purchases.
Special Events
Making exempt sales where a Certificate of Resale is issued.
Street Vendor and Mobile Food Services.
Specialized Sales
30. Date when sales/use began in DC (MM/DD/YYYY) ______/______/______ or date expected to begin.
31. If you have more than one place of business where you collect taxes on sales
in DC, please attach a statement listing the additional places of business.
PART V — Personal Property Tax Registration
Describe the type of Personal Property at each location (ex. furniture, fixtures, machinery equipment and supplies), used for business purposes.
PART VI — Ballpark Fee Registration
Are annual gross receipts greater than $5 million?
Yes
No
Begin date (MMDDYYYY) __ /___/____
End date (MMDDYYYY) ___/___/____
PART VII — Tobacco Products Excise Tax Registration
Yes
No
Begin date (MMDDYYYY) ____/____/________
End date (MMDDYYYY) ____/____/________
PART VIII, Section 1 — Nursing Facility/Registration
Yes
No
Begin date (MMDDYYYY) ____/____/________
End date (MMDDYYYY) ____/____/________
PART VIII, Section 2 — Intermediate Care Facility for Persons with Intellectual or Developmental Disabilities (ICF-IDD) Tax Registration
Yes
No
Begin date (MMDDYYYY) ____/____/________
End date (MMDDYYYY) ____/____/________
PART VIII, Section 3 — Hospital Revenue Assessment
Yes
No
Begin date (MMDDYYYY) ____/____/________
End date (MMDDYYYY) ____/____/________
PART VIII, Section 4 — Hospital Provider Fee
Yes
No
Begin date (MMDDYYYY) ____/____/________
End date (MMDDYYYY) ____/____/________

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