HomeMy WebLinkAboutEDA Employer ID Form SS-4
#5505
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Fonn
88-4
SIN 41-1891530
Application for Employer Identification Number
(For use by employers, corporations, partnerships. trusts, estates, churchea,
(Rev. OecsmbM 1995) government agencies, certain Indlyjduals, and others. See Instructions.)
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Internal Aev.nu. SeMee ~ Keep a copy for your records.
1 Name at applicant (~egaJ name) (See instructions.)
~ Columbia Heights Economic Development Authority
'i 2 Trade name ot business (If different from name on line 1) 3 Executor. trustee, "care of' name
~ N/A
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OMS No. 154~HJ003
Walter R. Fehst
Sa 8usiness address (If different from address on Hnes 4a and 4b)
N/A
5b City, state. and ZIP code
N/A
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4a Maillng address (street address) (room. apt.. or suite no.)
590 40th Avenue N.E.
4b City. state, and ZIP code
Columbia Heights, MN 55421
a County and state where principal business is located
Anoka County, State of Minnesota
7 Name of principal officer. general partner, grantor. owner. or trustor-SSN required (See instl1JC':Jor.s.) ..
N/A
Sa Type of entity (Check only one box.1 (See,instructlons.)
o Sole propnetor (SSN) ::
o Partnership 0 Personal service corp.
o AEMIC 0 Umlted liability co.
IZI State/lccal govemment 0 National Guard
o Other nonprofit organization (specify) ~
o Other soecitv ~
8b If a corporation. name the state or foreign country State
(If applicable) where incorporated N /A
o Estate (SSN of decedent)
o Plan admlnlstrator.SSN
o Other corporatlcn (specify) ~
o Trust 0 Farmers' cooperative
o Federal GovemmenVmilltary 0 Church or church-oontrolled organization
(enter GEN it applicable)
I Foreign country
9
o Banking purpose (specify) ~
o Changed type at organization (specify) ~
o Purchased going business
o Created a trust (specify) ~
Aeason for applying (Check only one box.)
IZI Started new business (specify) ~
public body corporate and politic
o Hired employees
o Created a oenslon Ian (soeci e"
Date business started or acquired (Mo.. day, year) (See instructions.)
01/08/96
o Other (specify) ..
11 Closing month ot accounting year (See instructions.)
December 31
10
12
First date wages or annuities were paid or will be paid (Mo.. day, year). Note: If applicant is a withholding agent. enter date income will first
be paid to nonresident aiien. (Mo.. day. year) , . ." N/A
Highest number ot employees expected in the next 12 months. Note: If the applicant does Nonagricultural
not expect to have any employees during the period, enter -0-. (See instructIons.). . ." N/A
Pnncipal activity (See instructions.) .. Governmental economic development author~ ty
Is the principal business activity manufacturing? . . . . .
If "Yes." principal prodUct and raw material used ..
To whom are most of the products or services said? Please check the appropriate box.
o Public (retail) 0 Other (specify) ~
13
Household
14
15
o Ves
IJ! No
16
o Business (wholesale)
IZI
IXI No
N/A
17a
o Ves
17b
Has the applicant ever applied for an identlffcatlon number for this or any other business?
Note: If "Yes. " please complete lines 17b and 17c.
If you checked "Yes" on Une 17a. givo applicant's legal name and trade name shown on prior application. if different tram line 1 or 2 .:::bave.
Legal name" Trade name ..
Approximate date when and city and state where the application was flied. Enter previous employer identification number if known.
Approximate date when flied (Mo.. day. year) City and state where flied Previous EIN
170
Under penalties of perjury, I declare tf1at J have examined this applicatlon, and to the best of my knowJedoe and belief, it is true. correct. and complete. Business t.lephoftl number (InClud. area CGd.)
(612) 782-2810
Fut.lephan.nllmbll{lncJud.areICGd.,
R. Fehst, Executive Director (612) 782-2801
SJgnature ..
Date ~ or'/,:;J-'! /'1
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Note: Do not write below this line. For off/da/ use only.
Ind. Class Size
Please leave Goo.
blank ~
For Paperwork Reduction Act Notice, see page 4.
Reason for applying
CaL No. 15055N Fonn 55-4 (Aev. 12-95)
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