Application For Earned Income Taxpayer Account - City Of Wilmington
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1APPLICATION FOR EARNED INCOME
TAXPAYER ACCOUNT
City of Wilmington, Delaware
Account #
Department of Finance
Wage Tax/Business License Division
800 North French Street
Wilmington, DE 19801-3537
Specific Nature of Business
(302) 576-2418
City of Wilmington Ordinance No. 78-015, Section 30-33 provides, in part, that subject to the Earned Income Tax regulations are: “Each employer
who employs one or more persons subject to this tax . . . shall deduct monthly or more often than monthly . . . the full tax . . . on the salaries, wages,
commissions, and other compensation due from such employer . . .
Complete And Submit This Form To The EARNED INCOME TAX DIVISION To Request
Establishment Of An Earned Income Taxpayer Account
Type of Ownership:
Corporation
S - Corporation*
Employer
TYPE OF ACCOUNT REQUESTED
Partnership*
Sole Proprietor
Net Profit
Estate/Trust
Non-Profit (501C3 copy required)
Holding Company, (if exempt under DEL. 1902(B)(8), Title 30 proof of exemption must be attached)
LLC
Other
! Federal Employer Identification No.: __________________________
IDENTIFICATION NUMBER
! If no FEI, enter Social Security No.:
__________________________
Applicant’s Business Location:
Actual physical location or physical location where work will be performed. P.O. Box is not acceptable.
)
E-MAIL ADDRESS
CONTACT PERSON
NAME OF BUSINESS (No more than 30 characters including spaces
ADDRESS LINE 1
FAX NUMBER
First Name
ADDRESS LINE 2
Last Name
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
Telephone Number
Mailing Address:
Address applicant desires information and tax forms to be mailed.
NAME OF BUSINESS
E-MAIL ADDRESS
ADDRESS LINE 1
ADDRESS LINE 2
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
FAX NUMBER
Business Owner Information:
Actual physical location required. P.O. Box Address is not acceptable.
NAME OF BUSINESS OWNERS
E-MAIL ADDRESS
ADDRESS LINE 1
ADDRESS LINE 2
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
FAX NUMBER
NAME: (typed)
TITLE:
Date
SIGNATURE:
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Parent category: Financial