Form Ibr-1 - Idaho Business Registration Form

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F
IBR-1
Idaho Business Registration Form
O
Revised
R
2014
EFO00147
Register online at: business.idaho.gov
M
01-07-14
Fax to: (208) 334-5364
IDAHO BUSINESS REGISTRATION
SHADED AREAS FOR STATE USE ONLY
Return to:
PO BOX 36
Account Number
Confirmation No.
BOISE, IDAHO 83722-0410
1a. If LLC, how have you chosen to be
___ Corporation
___ Partnership
___ S Corporation
___ Sole Proprietorship
1. Type of business
taxed for income tax purposes?
Single Member
Corporation
___ Nonprofit
___ Government
___ Fiduciary/Trust
___ Limited Liability Company
(see instructions)
Partnership
S Corporation
___ New applicant
___ Change legal name
___ Change assumed business name (DBA)
2. Purpose of registration
___ Add new account type ___ Add/change location
___ Change in partners, shareholders or managing members ____%
___ Boise Auditorium
___ City of Ketchum Local Option
__ E911 Prepaid Wireless Fee
___ Travel & Convention
3. Apply for permits/accounts
___ Sales
___ Use
___ Unemployment
___ Withholding
___ Withholding only, no employees working in Idaho
Request more information
___ Amusement Device
___ Beer/Wine
___ Cigarette/Tobacco
4. Federal Employer Identification Number (EIN)
5. Social Security number (SSN)
6. Legal business name (see instructions)
8. Date incorporated
9. State incorporated in
10. Month tax year ends
7. Assumed business name (DBA)
11. Date business began in Idaho
12. Date sales or use
13. Estimated monthly taxable sales
will begin in Idaho
month
year
14. Physical location of
Street address
City
State
Zip Code
business (no PO Box or
mail drop addresses)
15. Mailing address
Street address or PO Box
City
State
Zip Code
Street address or PO Box
City
State
Zip Code
16. Mailing address
for report forms
18. Authorized contact person (name and title) See instructions for definition.
17. Business telephone number
(
)
19. Telephone number & extension of contact person
20. Email address of contact person
21. Fax number of contact person
(
)
22. Primary nature of business: (Specify the product manufactured and/or sold or the type of service performed.)
23. Have you ever had a withholding, sales, use, workers' compensation or unemployment insurance number in Idaho? If yes, list all permit, account or
policy numbers. (It is your responsibility to cancel any existing accounts you no longer need.)
24. List (a) owner and spouse of sole proprietorship, (b) all partners of partnership, (c) all corporate officers of corporation, (d) trustee or responsible party of
fiduciary or trust, or (e) all members of limited liability companies. Social Security number required for every individual listed. (Use additional sheet
If necessary.)
Corp
%
Director?
Compensated?
Name
Address of Residence
SSN/EIN and Phone Number
Title
Owned
Yes/No
Yes/No
CERTIFICATION: I certify that I am authorized as an owner, partner, corporate officer, member or representative to sign this document and that the statements
made are correct and true to the best of my knowledge. (This form must also be signed by the spouse of a sole proprietor.)
Print name____________________________________________ Signature_________________________________________________ Date________
Print name____________________________________________ Signature_________________________________________________ Date________

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