Form Reg-1 - Application For Registration - 1996
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1
2STATE OF NEW JERSEY
MAIL TO:
REG-1
CN 252
DIVISION OF TAXATION
(12-96)
TRENTON, NJ 08646-0252
APPLICATION FOR REGISTRATION
Read instructions before completing this form
ALL SECTIONS MUST BE FULLY COMPLETED ON BOTH SIDES OF THIS APPLICATION
A. Please indicate the reason for your filing this application (Check only one box)
Original application for a new business.
Application for a new location of an existing business.
Amended application for an existing business.
Moved previously registered business to new location (REG-C or UTF-C can be used in lieu of REG-1)
Give name and NJ Registration Number of existing business.
_____________________________________________________________________________________________________________
Other - please explain_________________________________________________________________________________________
B. FID #
-
OR
Soc. Sec. # of Owner
-
-
Check Box if applied for (see Form REG-D on next page)
C. Name ________________________________________________________________________________________________________
(If INCORPORATED - give Corp. Name, IF NOT - give Last Name, First Name, MI of Owner, Partners)
D. Trade Name _______________________________________________________________________________________________
F. Mailing Name and Address:
(if different from business address)
E. Business Location:
(Do not use P.O. Box for Location Address)
Name_____________________________________________
Street _____________________________________
Street_____________________________________________
City __________________________________ State
City__________________________________ State
Zip Code
-
Zip Code
-
(Give 9-digit Zip)
(See instructions in REG-1A for providing alternate addresses)
(Give 9-digit Zip)
G. Beginning date for this business in New Jersey ____________ / __________ / __________ (see instructions)
month
day
year
H. Type of ownership (check one):
O/C ___________
NJ Corporation
Sole Proprietor
Partnership
Out-of-State Corporation
NCT
Limited Partnership
S Corporation
Limited Liability
Other _______________
FOR OFFICIAL USE ONLY
I. New Jersey Business Code
(see instructions)
DLN
B - _________________________
CORP #
_________________________
J. County / Municipality Code
(see instructions)
K. Will this business be open all year?
Yes
No
If NO - Circle months business will be open:
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG SEPT
OCT
NOV
DEC
L. Telephone Numbers: Contact Person ____________________________________
Title _________________________________
Daytime: (
) _______ - _______________ Ext._______
Evening: (
) _______ - _______________ Ext._______
M. IF A CORPORATION, complete the following:
Date of Incorp. __________ / ________ / __________
State of Incorp.
Fiscal month
month
day
year
Is this a Subsidiary of another corporation?
YES
NO
If YES, give name & Federal ID# of parent __________________________________________________________________________
N. Provide the following information for the owner, partners or responsible corporate offices. (If more space is needed, attach rider.)
NAME
SOCIAL SECURITY NUMBER
HOME ADDRESS
(Last Name, First, MI)
TITLE
(Street, City, State, Zip)
Signature
of Owner, Partner or Officer______________________________________________________________
Date_________________________________
Title_________________________________________________________________________________
BE SURE TO COMPLETE REVERSE SIDE
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