Form Bar - Business Application And Registration (Page 2 of 8) in pdf

Section C: Payroll Information

Amount of RI withholding taxes you expect to withhold

from employees each month.

Number of employees

Filing Status will be

$24,000 or more

Daily

First date wages paid in RI

$600 or more but less than $24,000

Quarter-Monthly

$50 or more but less than $600

Monthly

Are you -

Non-Profit_____Religious_____IRS Code 501-C-3_____

Less than $50.00

Quarterly

If any part of the business or its assets were acquired, please enter the date of acquisition, name, address and, if known, RI Employment Registration number of the former owner.

RI Employment Registration #

Date of Acquisition

month

day

year

Name of former owner

Trade Name

Street Address

City

State

Zip Code

If any employees were acquired from that business, please enter the number of employees acquired.

If you are a sole owner or partnership that is incorporating, state the name and address of the former business.

Name

Address

Section D Industry Description

D-1: Detailed information about your business is required in order to assign the correct industrial classification. In the space below describe your most important business

activities, goods, products or services in Rhode Island as though you were telling a prospective employee what you do. Please provide the approximate

percentage of sales or revenues resulting from each product or service. The total of percentages should equal 100%. If you have any questions regarding

this section, please refer to Instruction Sheet 2 or call the Rhode Island Department of Labor & Training's Labor Market Information unit

at (401) 462-8760 for assistance.

D-2 Establishment Locations: If you operate your business at more than one location in Rhode Island, please list the street address, city and zip code for each RI location

and the approximate employment for each location. If the business activities of any establishment differ from the above, please tell us the products or services of differing location.

Street

Town

Zip Code

Employees

Activity

Section E: Certification and Signature (Must be signed)

The undersigned certifies that the information given on this form is true and correct to the best of his or her knowledge and belief.

Date

Signature(s) of Applicant(s)

Print Name and Title

Form BAR

REV. 9/3/2010