Form Cra - Combined Registration Application - 2012 Page 2

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FORM
2012
Comptroller of Maryland
CRA
Combined Registration Application
Page 2
12CRA0149
FEIN or SSN ___ ___ ___ ___ ___ ___ ___ ___ ___
19. Are you a nonprofit organization applying for a sales and use tax exemption certificate?
Yes
No
Failure to enclose a non-returnable copy of IRS determination letter, articles of incorporation, bylaws, and other organization documents as described
in the instructions will result in your application being returned. If yes, See Instruction 8b.
20. Does the business have only one physical location in Maryland? (Do not count client sites or off site projects
Yes
No
that will last less than one year.)
If no, specify how many:
__________________________
21. Identify owners, partners, corporate officers, trustees, or members: (Please list person whose Social Security number is listed in Section A.1b first.)
*Partnerships, and Nonprofit organizations must identify at least two owners, partners, corporate officers, trustees or members. If more space is required, attach a
separate statement including the information as shown here.
Last Name
First Name
Social Security number
Title
1
Home Address
Street address
City
State
ZIP
Telephone
Last Name
First Name
Social Security number
Title
2
Home Address
Street address
City
State
ZIP
Telephone
Last Name
First Name
Social Security number
Title
3
Home Address
Street address
City
State
ZIP
Telephone
SECTION B: Complete this section to register for an unemployment insurance account.
PART 1
1. Will corporate officers receive compensation, salary or distribution of profits?
Yes
No
If yes, enter date (mm dd yyyy):
___ ___ ___ ___ ___ ___ ___ ___
2. Department Of Assessments & Taxation Entity Identification Number
___ ___ ___ ___ ___ ___ ___ ___ ___
3. Did you acquire by sale or otherwise, all or part of the assets, business, organization,
or workforce of another employer?
Yes
No
4. If your answer to question 3 is “No,” proceed to item 5 of this section. If your answer to question 3 is “Yes,” provide the information below.
a. Is there any common ownership, management or control between the current business and the former business?
Yes
No
b. Percentage of assets or workforce acquired from former business:
__________________________
c. Date former business was acquired by current business (mm dd yyyy):
___ ___ ___ ___ ___ ___ ___ ___
0 0
d. Unemployment insurance number of former business, if known:
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
e. Did the previous owner operate more than one location in Maryland?
How many? _______________________
Yes
No
5. For employers of domestic help only:
a. Have you or will you have as an individual or local college club, college fraternity or sorority a total payroll
Yes
No
of $1,000 or more in the State of Maryland during any calendar quarter?
b. If yes, indicate the earliest quarter and calendar year. (mm dd yyyy)
___ ___ ___ ___ ___ ___ ___ ___
6. For agricultural operating only:
a. Have you had or will you have 10 or more workers for 20 weeks or more in any calendar year or have you paid or will
Yes
No
you pay $20,000 or more in wages during any calendar quarter?
b. If yes, indicate the earliest quarter and calendar year. (mm dd yyyy)
___ ___ ___ ___ ___ ___ ___ ___
COM/RAD - 093
12-49

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