State Of Maine Registration Form printable pdf download

STATE OF MAINE REGISTRATION FORM

Pass-through Entity Withholding on Distributive Income

Required only for entities with nonresident owners

1. BUSINESS INFORMATION

Legal Name ___________________________________________

Doing Business As ______________________________________________________

Business Phone Number ________________________________

E-mail address _________________________________________________________

Fed. Employer’s ID # (FEIN) _____________________________

Street Address of Business Location (Physical Location) ________________________

Primary Mailing Address _________________________________

_____________________________________________________________________

____________________________________________________

_____________________________________________________________________

2003

2. REGISTRATION FOR PASS-THROUGH WITHHOLDING BEGINNING IN: _________________

3. WITHHOLDING TAX ACCOUNT ADDRESS (if different from above)

ADDRESS _____________________________________________

ATTENTION __________________________________________________________

_____________________________________________________

PHONE NUMBER _____________________________________________________

I certify that the information contained above is true, correct and complete to the best of my knowledge and belief. This application must be signed

by an owner, partner, member, officer, trustee or personal representative.

SIGNATURE

TITLE

DATE

PHONE NUMBER

PLEASE PRINT OR TYPE YOUR NAME

Instructions

Line 1. Enter the legal name of the business or organization. Examples are the partnership name or the exact name from the

Articles of Incorporation.

Enter the federal employer’s identification number (FEIN). An FEIN must be provided to register for Maine Income

Tax Withholding. To obtain an FEIN, file federal Form SS-4 with the Internal Revenue Service. For information on FEIN’s, call

the Andover Service Center in Massachusetts at (978) 474-9520, Maine Department of Labor, Central Registration Unit at (207)

287-2338 or visit the Maine Taxpayer Service Center in Augusta. Federal Form SS-4 can also be downloaded from the Internal

Revenue Services Internet site,

Also enter the business mailing address as well as the physical location address for the business.

Mail this application in the envelope provided or fax to: 1-207-287-3733.

Department of Labor, Central Registration Section, PO Box 1057 Augusta, ME 04332-1057

State Of Maine Registration Form