Form Reg-D - Federal Identification Number Reporting Form - State Of New Jersey Division Of Taxation

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MAIL TO:
REG-D
PO Box 252
STATE OF NEW JERSEY
(9-96)
TRENTON, N.J.
DIVISION OF TAXATION
08646-0252
FEDERAL IDENTIFICATION NUMBER REPORTING FORM
This form must be submitted to the Division of Taxation upon receipt of your Federal Identification Number.
Complete the entire form to ensure proper assignment of your Federal Identification Number.
A.
Federal Identification Number
-
B.
CURRENT INFORMATION:
0
0
0
New Jersey Registration Number
-
-
Name____________________________________________________________________________________________________
Trade Name ______________________________________________________________________________________________
Street ___________________________________________________________________________________________________
City _________________________________________ State ______________________ Zip Code ________________________
c.
Telephone Numbers: Contact Person ___________________________________ Title __________________________________
Daytime: (
)________-______________Ext.___________ Evening: (
)_________-______________Ext._________
Signature_______________________________________________________
Date________________________________________
Title ___________________________________________________________
Telephone (
) ___________________________

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