Form P-Ss-4 - Employer'S Withholding Registration Page 2
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26. TYPE OF BUSINESS OWNERSHIP (CHECK ONE ONLY)
(1) Individual
(2) Partnership
Registered Partnership Agreement Date:________
Limited Partnership
Identify all general partners above.
(3) Limited Liability Co.
(4) Corporation
Sub Chapter S
Professional
(5) Non-Profit Corporation
(6) Government
(7) Trust or Estate (Fiduciary)
(8) Other (Explain)______________________________________________
State of Incorporation
Michigan Corporation Number
7. DATE YOU FIRST PAID WAGES SUBJECT TO PORTLAND
CONTACT PERSON FOR WITHHOLDING TAX
WITHHOLDING
QUESTIONS (NAME AND PHONE)
NUMBER OF EMPLOYEES SUBJECT TO PORTLAND WITHHOLDING
8. REASON FOR REGISTRATION
Started a new business on ____________________
Incorporated an existing business
Purchased a going business. Complete item 9 below.
Reinstated an old business. Old account no.___________________
Stated doing business in Portland
Other (explain) _____________________________________________
9. NAME OF PREVIOUS OWNER OF CORPORATION
WILL THE PREVIOUS OWNER CONTINUE TO HAVE EMPLOYEES SUBJET TO THE PORTLAND INCOME TAX WITHHOLDING?
YES
NO
ST
10. DO YOU CLOSE YOUR BOOKS FOR TAX PURPOSES (FOR THE YEAR) ON DECEMBER 31
?
11. SIGNATURE (of the officer or owner who controls or is responsible for
TITLE
filing Returns, and making payments of Portland taxes.)
TYPE OR PRINT NAME
DATE
SIGNATURE
TITLE
TYPE OR PRINT NAME
DATE
Revised 10/2012
P-SS-4
Questions on this application? Call the Income Tax Department at (517) 647-2941
Mail To:
City of Portland
Income Tax Department
259 Kent Street
Portland, MI 48875
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