Form E-9 - Application For Earnings Tax Account
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1
2FORM E-9
COLLECTOR OF REVENUE - CITY OF ST. LOUIS - APPLICATION FOR EARNINGS TAX ACCOUNT
REV. 07/13
Please type or print - send to Gregory F.X. Daly, Collector of Revenue, 1200 Market Street, Room 410, St. Louis, MO 63103
Federal Employer ID Number or Social Security Number
Type of Organization: (Not for profit must supply copy of exemption certificate)
Individual Business or Professional Person
Partnership
Corporation
Not for Profit
Estate
Other (specify)
True Name
Reason for applying: (check one)
New Business
Purchased Business
Trade Name (Enter name if different than line above)
Withholding for City Resident Only
Other (Specify)
Address of Principal Place of Business
City, State, Zip Code
Telephone Number
(
)
Local Address (If different than above)
City, State, Zip Code
Local Telephone Number (If Different)
(
)
Date acquired or started within the city
First date wages are to be paid:
Type of Business
Calendar Year
of St. Louis:
Fiscal Year Ending
/
/
Have you ever applied for an Earnings Tax Account for this or
Print or Type Name of Owner
Partner
Officer
Title
any other business?
Yes
No (if Yes, enter FIDN or name)
Social Security Number
Signature
OFFICE USE ONLY:
Date
Approved by
Date
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Parent category: Financial