Publication 1635 - Understanding Your Employer Identification Numbers Page 25
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32Name and Title: Print your name and title (i.e., owner, president, vice-president, etc.).
Telephone Number: Enter the telephone number where we can reach you if we have
questions about your application.
Signature: The president, vice-president, or other principal officer must sign.
10. Bankruptcy (Individual/Sole Proprietor)
Line 1
Always enter the name of the receiver, debtor in possession, or bankruptcy trustee.
Line 2
N/A
Line 3
Always enter the name of the individual/sole proprietor who has gone into
bankruptcy.
Line 4a
Enter your trustee or receivers mailing address.
Line 4b
Enter your trustee or receiver’s city, state and zip code.
Lines 5a
and 5b Enter only if different from the mailing address.
Line 6
Enter the county and state where your principal business is located.
Line 7a
N/A and Line 7b N/A
Line 8a
Check “Other” and write in sole proprietor (or individual) bankruptcy, receivership,
or debtor in possession.
Line 8b
N/A
Line 9
Check “Other” and write in “bankruptcy”, “receivership”, or “debtor in possession”.
Line 10
Enter the date the bankruptcy was created.
Line 11
Enter the last month of your accounting year.
Line 12
N/A
Line 13
N/A
Line 14
N/A
Line 15
N/A
Line 16a-16c N/A
Complete Third Party Designee only if you want to authorize the named individual to receive the
EIN and answer questions about the completion of this form. If N/A, complete Name and
Title area only.
Name and Title: Print the name and title of the person signing below the signature line on Form
SS-4.
Telephone Number: Enter the telephone number where we can reach you if we have questions
about your application.
Signature: The fiduciary, trustee, receiver, or debtor in possession must sign.
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Parent category: Financial