Employer'S Registration Card - City Of Springfield
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1EMPLOYER'S REGISTRATION CARD
_ _ - _ _ _ _ _ _ _
(please complete & return)
Federal ID #
Income Tax Division • 601 Avenue A • Springfield, MI 49015-1499 • (616) 965-2354
Parent Company
Business Name
Name
Local Address
Parent Company
City-State-Zip
Mailing Address
Phone #
Phone #
Date business acquired:_______________________
Date first wages paid:_______________________
Type of organization:
______ Individual Owner
______ Partnership
______ Corporation
Owner's Name:______________________________
Financial Officer's Name:______________________________
Accounting Period:
______ Calendar Year
______ Fiscal Year Ending:______________________________
Was business previously operated by another employer?
______ yes
______ no
If yes, please provide name & address:_________________________________________________________________
__________________________
____________________________________________
_______________
Signed
Print Name & Title
Date
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Parent category: Financial