Employer'S Withholding Registration Form - City Of Grand Rapids
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1EMPLOYERS FEDERAL IDENTIFICATION NUMBER
GRAND RAPIDS INCOME TAX DEPARTMENT
(IF NOT REQUIRED – WRITE “NONE”)
EMPLOYER’S WITHHOLDING REGISTRATION
G.R.-
READ INSTRUCTIONS BEFORE FILLING OUT THIS FORM
TRADE NAME
1.
2.
EMPLOYER’S NAME (GIVE OWNER’S TRUE NAME
IF DIFFERENT FROM TRADE NAME ABOVE)
3.
GRAND RAPIDS BUSINESS ADDRESS
ZIP CODE
4. MAILING ADDRESS FOR TAX FORMS
ZIP CODE
LOCAL TELEPHONE
NO. OF
5.
CHECK TYPE OF ORGANIZATION
OTHER
6.
7.
NO.
EMPLOYEES
INDIVIDUAL OWNER
PARTNERSHIP
CORPORATION
(ATTACH EXPLANATION)
8.
DATE BUSINESS ACQUIRED BY EM-
MONTH
DAY
YEAR
9.
GIVE THE DATE YOU FIRST PAID WAGES
MONTH
DAY
YEAR
PLOYER SHOWN IN ITEM 2 ABOVE
/
/
SUBJECT TO GRAND RAPIDS WITHHOLDING
/
/
10.
WAS THIS BUSINESS PREVIOUSLY OPERATED BY ANOTHER
11.
IF ANSWER TO ITEM 10 IS “YES”, GIVE EMPLOYER’S NAME AND IDENTIFICATION
EMPLOYER?
YES
NO
NUMBER IF KNOWN.
SIGNTURE
TITLE
DATE
G.R.-SS-4
INSTRUCTIONS
Each employer withholding City of Grand Rapids Income Tax from employees’ wages should
register with the City Income Tax Department.
For the convenience of the employer, the Federal
Identification Number assigned to the employer by the Federal District Director of Internal Revenue will be
used for the City of Grand Rapids Income Tax department records. If an employer does not have a Federal
Identification Number at the time of filing the City of Grand Rapids Income Tax reports, application can be
made to the Federal District Director of Internal Revenue of Federal Form SS-4 for a number.
When for any reason the Federal Identification Number is not required, an identification number
will be assigned by the City of Grand Rapids Income Tax Department. If an employer is assigned a Federal
Number at a later date, he must notify the City Income Tax Department of the Federal Number assigned.
The employer will then be notified to discontinue the City of Grand Rapids Identification Number and use
the Federal number for all future City withholding purposes.
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