Form Sa-44a - Annual Retail Trade Report - 2011 Page 2
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6Form SA-44A
Page 2
(11-07-2011)
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FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)
Does this firm report payroll under EIN
Yes
EIN (9 digits)
No - Enter current 9-digit EIN AND date payroll was first
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reported for this EIN
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Month
Day
Year
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ORGANIZATIONAL CHANGE
A. Did this EIN experience any acquisitions, sales, mergers, and/or divestitures in 2011 or 2010?
Yes
No - Go to
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B. Which of the following organizational changes occurred in 2011 or 2010?
Check all that apply. If more than one organizational change occurred during the reporting period, explain in
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15
Month
Day
Year
Acquisition
Date of organizational change
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Sale
AND
Merger
Enter detailed information below
Divestiture
Name of company
EIN (9 digits)
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Address (Number and street, P.O. Box, etc.)
City
State
ZIP Code
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REPORTING PERIOD
What time period is covered by the data provided in this report?
2011
2011
Calendar year
Beginning Date
Ending Date
Month
Day
Year
Month
Day
Year
Fiscal or partial year - Report beginning and ending
dates.
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2010
2010
Beginning Date
Ending Date
Month
Day
Year
Month
Day
Year
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NUMBER OF ESTABLISHMENTS
2011
2010
How many retail establishments (including departments and concessions) did this
EIN operate in 2011 and 2010?
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The remainder of this report refers to the establishments reported here.
CONTINUE ON PAGE 3
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