Payroll Processor'S Annual State Registration
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1PAYROLL PROCESSOR’S ANNUAL STATE REGISTRATION
(10 M.R.S.A., Chapter 222)
A payroll processor that conducts business in Maine must register with
Maine Revenue Services annually by January 30. A payroll processor
is a person that provides payroll processing services for employers
maintaining an office in Maine or transacting business in Maine and
making payment of wages taxable to Maine.
____________________________________________
_______________________
Payroll Processor Name
Federal ID#
________________________________________________________________________
Mailing Address
________________________________________________________________________
________________________________________
_____________
_____________
City/Town
State
ZIP Code
_________________________________________
_____________________________
Contact Person
Phone Number
Services performed (check all that apply)
Preparing/issuing payroll checks
Preparing/filing tax returns (including quarterly withholding/UC reports)
Collection/submission of employee income tax withholding
Collection/submission of unemployment insurance contributions
Other (list): _________________________________________________
Physical location where payroll processing services are performed
________________________________________________________________________
________________________________________________________________________
Under penalties of perjury, I declare that the information contained in this document is, to
the best of my knowledge and belief, true, correct and complete.
____________
__________________________________
_____________________
Date
Officer’s Signature
Title
Mail this form to:
Maine Revenue Services
Income/Estate Tax Division
24 State House Station
Augusta, ME 04333-0024
Note: A payroll processor that fails to register when required commits a civil violation and
is subject to penalties ranging from $500 to $2,500.
Criminal Violations: A payroll processor is a fiduciary for purposes of 17-A M.R.S.A.§903.
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