Form Cra - Combined Registration Application For State Of Delaware Business License And/or Withholding Agent - Division Of Revenue Page 37

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12. NATURE AND LOCATION OF BUSINESS IN DELAWARE (Indicate in sections a,b,c,d, and e).
(a). Street Address (Number & Name)
(b). City/County
(c). Zip Code
(d). Principal Types of Activity
Percent
(e). Principal Products or Services
Percent
(Manufacturer Wood Furniture, Food Super
of
(Leather Gloves, Electric Motors, TV Repairs, etc.)
of
Market, Truck Rental Etc.) EXPLAIN FULLY
Total
EXPLAIN FULLY
Total
Total
100.00
Total
100.00
13. Will any employee work primarily in Delaware?
Yes
No
If yes, skip 13(a). Go to #14
If no, complete 13(a) before going to #14.
13(a). Will any employee perform some work in Delaware? Yes
No
If no, go to #14
If yes, attach explanation. For each employee who does not work primarily in Delaware,
list all States where work is performed, the State where the base of operations is located,
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14. Name, title, address and telephone number of officer or representative to furnish payroll information.
? Yes
15.
No
Have you acquired the organization, trade or business, or substantially all the assets of another employing unit
If yes, provide the name and Federal Identification Number of the acquired entity.
16. If you have reorganized, has the ownership and management remained substantially the same? Yes
No
THIS REPORT MUST BE SIGNED HERE BY THE OWNER OR DULY AUTHORIZED REPRESENTATIVE
It is hereby certified that the information in this report and in any
attached sheets is true and correct, to the best of my knowledge,
and is submitted with the full knowledge that there are penalties
prescribed by law for misstatements. Application will not be
processed without an authorized signature.
(S
ignature Required
)
Title
Date
(Business Name)
NON-PROFIT EMPLOYERS ONLY
17. (a). Please submit the following documents:
(1) Copy of charter or articles on incorporation and by-laws
(2) Copy of Internal Revenue Status under IRS Code (Sec. 501-a)
(b). Do you have in your employ four (4) or more employees?
Yes
No
(c). Do you elect the reimbursement method in lieu of paying assessments? Yes
No
If yes, the department will send you form COM-4069.
(d). Do you wish to make reimbursement payments with another employer and establish a group account? Yes
No
If answer is yes, list the names and addresses of all employers in the group and the name and address of the group
representative who will act as the agent responsible for the disbursement of timely payments to the State of Delaware.

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Parent category: Financial