Form 301 - Application To Register For North Dakota Income Tax Withholding

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Office Of State Tax Commissioner
G06
Form
Application To Register For North Dakota Income Tax Withholding
1-3
301
Please enter your assigned federal employer identification number (EIN) below. The suffix will be assigned by this office. This 11-digit number will serve as your State ID No.
Federal employer identification number*
Suffix
1.
4
12
13
14
Name of business (trade name)
2.
15
38
If you abbreviated the business name
®
above, print full name here
______________________________________________________________________________
Legal name (if different from name on line 2)
3.
39
62
If you abbreviated the legal name
®
above, print full name here
______________________________________________________________________________
Telephone number
4.
X X 1 1
77
78
79
80
67
76
Mailing address
5.
15
38
City
State
Zip Code
6.
57
39
54
55
56
65
J Sole
J Corporation
J Partnership
J Other
J Government
J Limited
J S Corp
7.
Type of entity
(Check one)
proprietorship
liability co.
66
66
66
66
66
66
66
I
C
P
O
G
L
S
Month
Day
Year
8.
Enter date on which North Dakota income tax withholding began or will begin.
67
74
9.
If principal place of business is other than North Dakota, list name and address of home office
________________________________________________________
____________________________________________________________________________________________________________________________________
Phone no. (
) _______________________ Contact person
______________________________________________________________________________
10. Principal activity of business _______________________________________ Enter date business started operating in North Dakota ______/______/______.
11. If business is temporary, give an approximate period of time business will have activity in North Dakota: ______/______/______ through ______/______/______.
12. Provide an estimate of the number of employees in North Dakota and the total wages to be paid to them for the current year.
No. of employees ____________________
Wages $_________________________
The application must be signed as follows: If a sole proprietorship, the individual who owns the business must sign. If a partnership, a general partner must sign. If a
corporation, two of the following individuals must sign: president, vice president, secretary or treasurer. If a limited liability company, a governor or manager must sign.
__________________________________________________________________________________________________________________________________________
Printed name
Signature
Title
Social security number
__________________________________________________________________________________________________________________________________________
Home address
__________________________________________________________________________________________________________________________________________
Printed name (2nd name, if corporation)
Signature
Title
Social security number
__________________________________________________________________________________________________________________________________________
Home address
28224

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