Michigan Department of Treasury
3156 (2-98)
1. Federal Employer Identification Number (FEIN) if applicable
REGISTRATION FOR ALBION TAXES
2. Complete Company Name or Owner's Full Name (include, if applicable, Corp., Inc., P.C., L.C., L.L.C., L.L.P., etc.)
3. Business Name, Assumed Name or DBA (as registered with the county)
4. Address where all legal contact should be made. Enter number and street .
Business Telephone
City, State, ZIP
County
5. Type of Business Ownership (check one only)
Individual
Partnership
Michigan Corporation
Other (Explain)
Husband - Wife
Limited Liability Co.
Non-Michigan Corporation
What date will that liability begin?
How much of each tax do you estimate you will owe each month?
6. Which taxes do you expect to owe?
Albion Income Tax Withholding
$0
Up to $65
Up to $300
Over $300
Mo.
Day
Year
How many people will you employ who
Corporation Income Tax
are subject to Albion withholding?
Mo.
Day
Year
Albion business location address
Partnership Income Tax
Mo.
Day
Year
You must complete all information for each owner, partner, member or corporate officer. Attach a separate list if necessary.
7A. Name (Last, First, Middle, Jr./Sr./lll)
Home Telephone
Title
Date of Birth
Residence Address (Number, Street)
Social Security Number
City, State, ZIP
Driver License/Michigan Identification
7B. Name (Last, First, Middle, Jr./Sr./lll)
Home Telephone
Title
Date of Birth
Residence Address (Number, Street)
Social Security Number
City, State, ZIP
Driver License/Michigan Identification
8. Do you close your tax books on Dec. 31?
If no, give month of closing.
Yes
No
9. What is the reason for this application?
Started a new business
Incorporated an existing business
Purchased an existing business
Other (explain below)
10. Name of previous owner(s) or corporation
11. Previous Owner's FEIN (if known)
This registration must be signed by the owner(s), two partners, two corporate officers, two members of a limited liability company or
their authorized representative. Applications without signatures will be returned.
I declare, under penalty of perjury, that I have examined this registration and its attachments and they are true and complete to the
best of my knowledge.
Type or print name of owner or officer responsible for filing returns and making tax payments.
Title
Signature
Phone
Date
Type or print name of second owner; partner; officer or member
Title
Signature
Phone
Date
Preparer's name and address if different from above.
Phone
Date