Form Cra - Combined Registration Application

Software Vendor Final 10.10.13

2014

Combined Registration

MARYLAND

FORM

Application

CRA

FEIN or SSN ___ ___ ___ ___ ___ ___ ___ ___ ___

19a. Are you a nonprofit organization applying for a sales and use tax exemption certificate?

Yes

If yes, FAILURE TO ENCLOSE REQUIRED DOCUMENTS WILL RESULT IN YOUR APPLICATION BEING REJECTED AND RETURNED. Please provide a non-

returnable copy of (1) IRS determination letter, (2) articles of incorporation, (3) bylaws, and (4) other organization documents as specified in the instructions. See

page 4, Sales and Use Tax Exemption Checklist and instructions.

19b. Are you a non-profit organization exempt under Section 501(c)(3) of the Internal Revenue Code?

Yes

If no, Section(c)(__) or Other: Section ____.

20. Does the business have only one physical location in Maryland? (Do not count client sites or off site projects

Yes

that will last less than one year.)

If no, specify how many:

__________________________

21. Identify owners, partners, corporate officers, trustees, or members: (Please list person whose Social Security Number is listed in Section A.1b first.)

*Partnerships and Nonprofit organizations must identify at least two owners, partners, corporate officers, trustees or members. If more space is required, attach a

separate statement including the information as shown here.

Last Name

First Name

Social Security Number

Title

Home Address

Street address

City

State

ZIP

Telephone

Last Name

First Name

Social Security Number

Title

Home Address

Street address

City

State

ZIP

Telephone

Last Name

First Name

Social Security Number

Title

Home Address

Street address

City

State

ZIP

Telephone

SECTION B: Complete this section to register for an unemployment insurance account.

PART 1

1. Will corporate officers receive compensation, salary or distribution of profits?

Yes

If yes, enter date (mmddyyyy):

___ ___ ___ ___ ___ ___ ___ ___

2. Department Of Assessments and Taxation Entity Identification Number

___ ___ ___ ___ ___ ___ ___ ___ ___

3. Did you acquire by sale or otherwise, all or part of the assets, business, organization,

or workforce of another employer?

Yes

4. If your answer to question 3 is “No,” proceed to item 5 of this section. If your answer to question 3 is “Yes,” provide the information below.

a. Is there any common ownership, management or control between the current business and the former business?

Yes

b. Percentage of assets or workforce acquired from former business:

____________________________

c. Date former business was acquired by current business (mmddyyyy):

___ ___ ___ ___ ___ ___ ___ ___

0 0

d. Unemployment insurance number of former business, if known:

___ ___ ___ ___ ___ ___ ___ ___ ___ ___

e. Did the previous owner operate more than one location in Maryland?

Yes

No How many? ________________________

5. For employers of domestic help only:

a. Have you or will you have as an individual or local college club, college fraternity or sorority a total payroll

Yes

of $1,000 or more in the State of Maryland during any calendar quarter?

b. If yes, indicate the earliest quarter and calendar year (mmddyyyy):

___ ___ ___ ___ ___ ___ ___ ___

6. For agricultural operating only:

a. Have you had or will you have 10 or more workers for 20 weeks or more in any calendar year or have you paid or will

Yes

you pay $20,000 or more in wages during any calendar quarter?

b. If yes, indicate the earliest quarter and calendar year (mmddyyyy):

___ ___ ___ ___ ___ ___ ___ ___

COM/RAD 093

13-49

Form Cra - Combined Registration Application - 2014 Page 2

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