Fillable City of East Lansing EL-SS-4 Employers Withholding Registration (ADP)

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City of East Lansing EL-SS-4 Employers Withholding Registration (ADP)

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The City of East Lansing EL-SS-4 Employers Withholding Registration (ADP) form is 3 pages long and contains:

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  • 37 check-boxes
  • 122 other fields

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Part I. Identification and addresses of employer or certified professional employer organization
1. Employer application 2. Certified professional employer organization (CPEO) co-employer application
3. Complete company name (include, if applicable, Corp., Inc., LLC, etc.) 4. Federal Employer Identification Number
5. Business name, assumed name or DBA (if used) 6. Business phone number
7. Enter street number and name (include apartment or suite number after street name)
8. Enter Address Line 2:
9. City
10. State
11. Zip Code
12. Enter street number and name (include apartment or suite number after street name)
13. Enter Address Line 2:
14. City
15. State
16. Zip Code
17. Enter street number and name (include apartment or suite number after street name)
18. Enter Address Line 2:
19. City
20. State
21. Zip Code
Part II. General information
1. Date first wages subject to city withholding paid
1a. 7. Reinstated old business; enter old FEIN7a.
2. Number of employees subject to city withholding
2a.
8. Started "doing business" in city; enter date
8a.
3. Reasons for filing withholding registration 9. CPEO with new client in the city. Enter client's FEIN on line 9a and
4. Started a new business; enter date 4a.
complete items 11 and 12 below
9a.
5. Incorporated an existing busines 10. Other (explain) 10a.
6. Purchased a going business (complete items 11 and 12 below)
11. Name of previous owner or PEO's client 12. Will the previous owner or PEO's client continue to 12a. Yes
x have employees subject to city income tax withholding
12b. No
13. Does your tax year end in December 31
13a. Yes 13b. No If no, provide the fiscal year end month and day 13c.
Part. III. Income tax withholding - Filing and payment of income tax withheld
Check box below to indicate how withholding tax returns are prepared and filed
1. Our withholding tax returns are prepared in house, filed and paid
5. An IRC Section 3504 agent is authorized to prepare, file and pay
X and all returns and Forms W-2 are filed and paid under our FEIN X our withholding tax returns and Forms W-2; all withholding tax
2. A common paymaster prepares our withholding tax returns:
X returns and Forms W-2 are filed under the agents FEIN. Attach a
X Withholding tax is paid under FEIN
2a.
X copy of federal Form 2678. ATTACH A COMPLETED FORM
X Forms W-2 are filed under FEIN
2b.
EL-2678 AS A PART OF THIS REGISTRATION
3. A payroll services provider prepares our withholding tax returns 6. A professional employer organization is authorized under a PEO
X and Forms W-2. Returns and Forms W-2 are filed and paid under X agreement to prepare, file and pay our withholding tax returns
X our FEIN X and Forms W-2 under their FEIN. Attach a copy of the PEO
X agreement. A certified PEO must be registered with the city as a
X co-employer liable for filing and payment of withholding tax
X under our FEIN. Attach a copy of Form 8655 filed with the IRS.
7. We are a CPEO preparing, filing and paying or clients city
ATTACH A COMPLETED FORM EL-8655 AS PART OF THIS
X withholding tax under our FEIN. Attach a copy of the IRS
X REGISTRATION
X certification.
Month (MM)
Day (DD)
City of East Lansing
EL-SS-4
PLEASE T
YPE
OR PRINT
INCOME TAX DEPARTMENT
PLEASE T
YPE
OR PRINT
Employer’s Withholding Registration
PHYSICAL
ADDRESS OF
PROJECT OR
ACTIVITY
IN CITY
EL-SS-4
LEGAL
ADDRESS
MAILING
ADDRESS
Complete company name (include, if applicable, Corp., Inc., LLC, etc.) Federal Employer Identification Number
Part IV. Type of business ownership (Check all boxes that apply)
1. Individual/Sole Proprietorship (Identify owner in 8. Michigan Corporation (Identify all corporation officers in
X Part III below) X Part III below)
2. General Partnership 8a. Michigan Subchapter S Corporation
X (Identify all partners in Part III below)
8b. Michigan Professional Corporation
3. Limited Partnership (LP)
9. Foreign (Non-Michigan) Corporation (Identify all corporation
X (Identify general partners in Part III below)
X officers in Part III below)
4. Professional Limited Liability 9a.Foreign Subchapter S Corporation
5. Partnership (LLP) (Identify all
10. Nonprofit Corporation (Identify all corporation officers in
X General Partners in Part III below)
X Part III below)
6. Limited Liability Company (LLC) 11. Government
X (Identify all members in Part III below)
12. Estate (Identify estate administrator or personal
7. Professional Limited Liability Company (PLLC)
X representative in Part III below)
X (Identify all members in Part III below)
13. Trust (Identify trustee in Part III below)
14. Other (explain)
Part V. Identification of each owner, partner, member or corporate officer (Attach Part VIII if more than 2)
1a. Name (last, first middle, suffix) 1g. Home Telephone Number
1b. Business Title 1h. Date of Birth
1c. Residence Address (street number and name including apartment number after street name) 1i. Social Security Number
1d. City
1e. State
1f. Zip Code 1j. Drivers License Number/ ST ID Number
2a. Name (last, first middle, suffix) 2g. Home Telephone Number
2b. Business Title 2h. Date of Birth
2c. Residence Address (street number and name including apartment number after street name) 2i. Social Security Number
2d. City
2e. State
2f. Zip Code 2j. Drivers License Number/ ST ID Number
Part VI. Contact information
1. Contact person for withholding tax questions 2. E-mail address of contact person
3. Phone number for contact person above.
3a.
Part VII. Signature area
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is
true, correct, and complete.
1a. Signature (owner, member or officer who controls or is responsible for 1b. Title
1c. Type or print name of person signing above 1d. Date
Mail to: East Lansing Income Tax Withholding
Form EL-SS-4, page 2, revised 10/26/2018
410 Abbot Rd, East Lansing, MI 48823
EL-SS-4 Questions about this application? Call the Income Tax Department at 517.319.6862
Information collected on this form is confidential pursuant to MCL 141.674(1), Michigan Uniform City Income Tax Ordinance; Sec.74(1).
Information gained by the administrator, city treasurer or any other city official, agent or employee as a result of a return, investigation,
hearing or verification required or authorized by this ordinance is confidential, except for official purposes in connection with the
administration of the ordinance and except in accordance with a proper judicial order.
Complete company name (include, if applicable, Corp., Inc., LLC, etc.) Federal Employer Identification Number
Part VIII. Identification of each owner, partner, member or corporate officer (Part V Continued)
3a. Name (last, first middle, suffix) 3g. Home Telephone Number
3b. Business Title 3h. Date of Birth
3c. Residence Address (street number and name including apartment number after street name) 3i. Social Security Number
3d. City
3e. State 34f. Zip Code 3j. Drivers License Number/ ST ID Number
4a. Name (last, first middle, suffix) 4g. Home Telephone Number
4b. Business Title 4h. Date of Birth
4c. Residence Address (street number and name including apartment number after street name) 4i. Social Security Number
4d. City
4e. State
4f. Zip Code 4j. Drivers License Number/ ST ID Number
5a. Name (last, first middle, suffix) 5g. Home Telephone Number
5b. Business Title 5h. Date of Birth
5c. Residence Address (street number and name including apartment number after street name) 5i. Social Security Number
5d. City
5e. State
5f. Zip Code 5j. Drivers License Number/ ST ID Number
6a. Name (last, first middle, suffix) 6g. Home Telephone Number
6b. Business Title 6h. Date of Birth
6c. Residence Address (street number and name including apartment number after street name) 6i. Social Security Number
6d. City
6e. State
6f. Zip Code 6j. Drivers License Number/ ST ID Number
7a. Name (last, first middle, suffix) 7g. Home Telephone Number
7b. Business Title 7h. Date of Birth
7c. Residence Address (street number and name including apartment number after street name) 7i. Social Security Number
7d. City
7e. State
7f. Zip Code 7j. Drivers License Number/ ST ID Number
8a. Name (last, first middle, suffix) 8g. Home Telephone Number
8b. Business Title 8h. Date of Birth
8c. Residence Address (street number and name including apartment number after street name) 8i. Social Security Number
8d. City
8e. State
8f. Zip Code 8j. Drivers License Number/ ST ID Number
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City of East Lansing EL-SS-4 Employers Withholding Registration (ADP)

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Completed 8 February 2021

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