Employers Withholding Registration Form
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1
2CITY OF DETROIT — FINANCE DEPARTMENT — INCOME TAX DIVISION
EMPLOYERʼS WITHHOLDING REGISTRATION
Incomplete information will delay processing of your registration. Type or print legibly and
IMPORTANT
complete all applicable items. Please read both instructions and registration carefully.
1. KIND OF OWNERSHIP OF THIS BUSINESS (Check applicable box(es).)
(1) Individual
(4) Domestic Corporation
(6) Trust or Estate (Fiduciary)
(2) Husband - Wife
(1) Subchapter S
(7) Joint Stock Club or Investment Co.
(3) Partnership
(2) Professional
(8) Social Club or Fraternal Org.
(3) Registered Partnership, Date:
(5) Foreign Corporation
(9) Other (Explain)
(3) Limited Partnership
(1) Subchapter S
State of
Federal
Incorporation
I.D. No.
Corporations Only: Which federal income tax returns will you file?
1120
1120S
990C
990T
Other
2a. GIVE DATE THAT LIABILITY WILL BEGIN FOR DETROIT INCOME TAX WITHHOLDING.
Mo.
Day
Year
2b. GIVE DATE THAT YOU FIRST PAID WAGES SUBJECT TO DETROIT INCOME TAX WITHHOLDING.
Mo.
Day
Year
3. WAS THIS BUSINESS PREVIOUSLY OPERATED BY ANOTHER EMPLOYER?
YES
NO
4. IF ANSWER TO ITEM 3 IS “YES,” GIVE EMPLOYERʼS NAME AND IDENTIFICATION NO. IF KNOWN.
5. LIST NAME(S) OF OWNER, ALL PARTNERS OR CORPORATE OFFICERS. (Attach an additional list if necessary.)
A. NAME (Last, First, Middle) (Jr./Sr., III, etc.)
Title
Residence Address (Number and Street)
City, State, ZIP
Home Telephone No.
Social Security Number
Driverʼs License No./Mich. Personal Identification No.
Date of Birth
B. NAME (Last, First, Middle) (Jr./Sr., III, etc.)
Title
Residence Address (Number and Street)
City, State, ZIP
Home Telephone No.
Social Security Number
Driverʼs License No./Mich. Personal Identification No.
Date of Birth
C. NAME (Last, First, Middle) (Jr./Sr., III, etc.)
Title
Residence Address (Number and Street)
City, State, ZIP
Home Telephone No.
Social Security Number
Driverʼs License No./Mich. Personal Identification No.
Date of Birth
6. BUSINESS, TRADE, ASSUMED NAME OR DBA (if used)
7. LEGAL ADDRESS OF BUSINESS (Where all legal contact by INCOME TAX DIVISION should be made.)
Number and Street
Business Telephone No.
City, State, ZIP
County
8. MAILING ADDRESS (Where INCOME TAX DIVISION will send all tax forms, if different from 7.)
Number and Street, P.O. Box, City, State, ZIP
9. ACTUAL LOCATION OF BUSINESS (if different from 7.)
Number and Street, City, State, ZIP
Signature of Responsible Person
Title
Date
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