8
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
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INSTRUCTIONS TO PRINTERS
FORM SS-4, PAGE 1 of 2
MARGINS: 25mm (1") HEAD, CENTER SIDES. PRINTS: HEAD to FOOT
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216mm (8
1
2 ") X 559mm (22"), FOLD TO 216mm (8
1
2 ") X 279mm (11")
PERFORATE: NONE
Application for Employer Identification Number
Form
SS-4
EIN
(Rev. July 2007)
(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, administrator, 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 (if foreign, see instructions)
4b
City, state, and ZIP code (if foreign, see instructions)
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). Caution. If 8a is “Yes,” see the instructions for the correct box to check.
9a
Partnership
Plan administrator (TIN)
Sole proprietor (SSN)
Farmers’ cooperative
Corporation (enter form number to be filed)
!
Personal service corporation
REMIC
Church or church-controlled organization
National Guard
Trust (TIN of grantor)
Group Exemption Number (GEN) if any
!
Other nonprofit organization (specify)
!
Other (specify)
!
9b
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)
10
Purchased going business
Started new business (specify type)
!
Hired employees (Check the box and see line 13.)
Created a trust (specify type)
!
Created a pension plan (specify type)
!
Banking purpose (specify purpose)
!
Other (specify)
!
12
11
Closing month of accounting year
Date business started or acquired (month, day, year). See instructions.
15
First date wages or annuities were 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 (enter -0- if none).
17
Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.
18
Has the applicant entity shown on line 1 ever applied for and received an EIN? Yes No
Complete this section only if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form.
Designee’s telephone number (include area code)
Date
!
Signature
!
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Form SS-4 (Rev. 7-2007)
Type or print clearly.
Cat. No. 16055N
Foreign country
State
Designee’s fax number (include area code)
!
See separate instructions for each line.
()
()
!
Keep a copy for your records.
Compliance with IRS withholding regulations
SSN, ITIN, or EIN
7b
Other
Applicant’s telephone number (include area code)
Applicant’s fax number (include area code)
()
()
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.
Name and title (type or print clearly)
!
Third
Party
Designee
Designee’s name
Address and ZIP code
Federal government/military
Indian tribal governments/enterprises
State/local government
Do you expect your employment tax liability to be $1,000
or less in a full calendar year? Yes No (If you
expect to pay $4,000 or less in total wages in a full
calendar year, you can mark “Yes.”)
Is this application for a limited liability company (LLC) (or
a foreign equivalent)?
No
Yes
8a
If 8a is “Yes,” enter the number of
LLC members
!
8b
If 8a is “Yes,” was the LLC organized in the United States?
8c
No
Yes
14
Check one box that best describes the principal activity of your business.
16
Construction
Real estate
Rental & leasing
Manufacturing
Transportation & warehousing
Finance & insurance
Health care & social assistance
Accommodation & food service
Other (specify)
Wholesale-agent/broker
Wholesale-other
Retail
If “Yes,” write previous EIN here
!
8
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
DO NOT PRINT DO NOT PRINT DO NOT PRINT DO NOT PRINT
INSTRUCTIONS TO PRINTERS
FORM SS-4, PAGE 2 of 2
MARGINS: TOP 13mm (
1
2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216mm (8
1
2 ") x 279mm (11")
PERFORATE: NONE
Do I Need an EIN?
File Form SS-4 if the applicant entity does not already have an EIN but is required to show an EIN on any return, statement,
or other document.
1
See also the separate instructions for each line on Form SS-4.
IF the applicant...
AND...
THEN...
Started a new business
Hired (or will hire) employees,
including household employees
Opened a bank account
Changed type of organization
Purchased a going business
3
Created a trust
Created a pension plan as a
plan administrator
5
Is a foreign person needing an
EIN to comply with IRS
withholding regulations
Is administering an estate
Is a withholding agent for
taxes on non-wage income
paid to an alien (i.e.,
individual, corporation, or
partnership, etc.)
Is a state or local agency
Is a single-member LLC
Is an S corporation
Does not currently have (nor expect to have)
employees
Does not already have an EIN
Needs an EIN for banking purposes only
Either the legal character of the organization or its
ownership changed (for example, you incorporate a
sole proprietorship or form a partnership)
2
Does not already have an EIN
The trust is other than a grantor trust or an IRA
trust
4
Needs an EIN for reporting purposes
Needs an EIN to complete a Form W-8 (other than
Form W-8ECI), avoid withholding on portfolio assets,
or claim tax treaty benefits
6
Needs an EIN to report estate income on Form 1041
Is an agent, broker, fiduciary, manager, tenant, or
spouse who is required to file Form 1042, Annual
Withholding Tax Return for U.S. Source Income of
Foreign Persons
Serves as a tax reporting agent for public assistance
recipients under Rev. Proc. 80-4, 1980-1 C.B. 581
7
Needs an EIN to file Form 8832, Classification
Election, for filing employment tax returns, or for
state reporting purposes
8
Needs an EIN to file Form 2553, Election by a Small
Business Corporation
9
Complete lines 1, 2, 4a–8a, 8b–c (if applicable), 9a,
9b (if applicable), and 10–14 and 16–18.
Complete lines 1, 2, 4a–6, 7a–b (if applicable), 8a,
8b–c (if applicable), 9a, 9b (if applicable), 10–18.
Complete lines 1–5b, 7a–b (if applicable), 8a, 8b–c
(if applicable), 9a, 9b (if applicable), 10, and 18.
Complete lines 1–18 (as applicable).
Complete lines 1–18 (as applicable).
Complete lines 1–6, 9a, 10–12, 13–17 (if applicable),
and 18.
Complete lines 1–5b, 7a–b (SSN or ITIN optional),
8a, 8b–c (if applicable), 9a, 9b (if applicable), 10,
and 18.
Complete lines 1, 3, 4a–5b, 9a, 10, and 18.
Complete lines 1, 2, 3 (if applicable), 4a–5b, 7a–b (if
applicable), 8a, 8b–c (if applicable), 9a, 9b (if
applicable), 10 and 18.
Complete lines 1, 2, 4a–5b, 9a, 10 and 18.
Complete lines 1–18 (as applicable).
Complete lines 1–18 (as applicable).
1
2
3
Do not use the EIN of the prior business unless you became the “owner” of a corporation by acquiring its stock.
4
However, grantor trusts that do not file using Optional Method 1 and IRA trusts that are required to file Form 990-T, Exempt Organization Business Income Tax
Return, must have an EIN. For more information on grantor trusts, see the Instructions for Form 1041.
5
A plan administrator is the person or group of persons specified as the administrator by the instrument under which the plan is operated.
6
Entities applying to be a Qualified Intermediary (QI) need a QI-EIN even if they already have an EIN. See Rev. Proc. 2000-12.
7
See also Household employer on page 4 of the instructions. Note. State or local agencies may need an EIN for other reasons, for example, hired employees.
8
Most LLCs do not need to file Form 8832. See Limited liability company (LLC) on page 4 of the instructions for details on completing Form SS-4 for an LLC.
9
An existing corporation that is electing or revoking S corporation status should use its previously-assigned EIN.
Complete lines 1–18 (as applicable).
Form SS-4 (Rev. 7-2007)
Page 2
Printed on recycled paper
For example, a sole proprietorship or self-employed farmer who establishes a qualified retirement plan, or is required to file excise, employment, alcohol, tobacco, or
firearms returns, must have an EIN. A partnership, corporation, REMIC (real estate mortgage investment conduit), nonprofit organization (church, club, etc.), or
farmers’ cooperative must use an EIN for any tax-related purpose even if the entity does not have employees.
However, do not apply for a new EIN if the existing entity only (a) changed its business name, (b) elected on Form 8832 to change the way it is taxed (or is
covered by the default rules), or (c) terminated its partnership status because at least 50% of the total interests in partnership capital and profits were sold or
exchanged within a 12-month period. The EIN of the terminated partnership should continue to be used. See Regulations section 301.6109-1(d)(2)(iii).