Application for Employer Identification Number
Form SS-4
EIN
(Rev. December 2001)
(For use by employers, corporations, partnerships, trusts, estates, churches,
government agencies, Indian tribal entities, certain individuals, and others.)
OMB No. 1545-0003
Department of the Treasury
Internal Revenue Service
Legal name of entity (or individual) for whom the EIN is being requested
1
Executor, trustee, “care of” name
3
Trade name of business (if different from name on line 1)
2
Mailing address (room, apt., suite no. and street, or P.O. box)
4a
Street address (if different) (Do not enter a P.O. box.)
5a
City, state, and ZIP code
4b
City, state, and ZIP code
5b
County and state where principal business is located
6
Name of principal officer, general partner, grantor, owner, or trustor
7a
Estate (SSN of decedent)
Type of entity (check only one box)
8a
Partnership
Plan administrator (SSN)
Sole proprietor (SSN)
Farmers’ cooperative
Corporation (enter form number to be filed)
Personal service corp.
REMIC
Church or church-controlled organization
National Guard
Trust (SSN of grantor)
Group Exemption Number (GEN)
Other nonprofit organization (specify)
Other (specify)
8b
If a corporation, name the state or foreign country
(if applicable) where incorporated
Changed type of organization (specify new type)
Reason for applying (check only one box)
9
Purchased going business
Started new business (specify type)
Hired employees (Check the box and see line 12.)
Created a trust (specify type)
Created a pension plan (specify type)
Banking purpose (specify purpose)
Other (specify)
11
10
Closing month of accounting year
Date business started or acquired (month, day, year)
12
First date wages or annuities were paid or will be paid (month, day, year). Note: If applicant is a withholding agent, enter date income will
first be paid to nonresident alien. (month, day, year)
Household
Agricultural
13
Highest number of employees expected in the next 12 months. Note: If the applicant does not
expect to have any employees dur