Form SS-4(Rev. December 2017) Department of the Treasury Internal Revenue Service Application for Employer Identification Number(For use by employers, corporations, partnerships, trusts, estates, churches, government agencies, Indian tribal entities, certain individuals, and others.) Go to www.irs.gov/FormSS4 for instructions and the latest information.See separate instructions for each line. Keep a copy for your records. OMB No. 1545-0003 EIN Type or print clearly. 1 Legal name of entity (or individual) for whom the EIN is being requested 2 Trade name of business (if different from name on line 1) 3 Executor, administrator, trustee, 223care of224 name4a Mailing address (room, apt., suite no. and street, or P.O. box) 5a Street address (if different) (Do not enter a P.O. box.) 4b City, state, and ZIP code (if foreign, see instructions) 5b City, state, and ZIP code (if foreign, see instructions) 6 County and state where principal business is located 7a Name of responsible party 7b SSN, ITIN, or EIN8a Is this application for a limited liability company (LLC) (or a foreign equivalent)? ........ Yes No 8bIf 8a is 223Yes,224 enter the number of LLC members ...... 8cYes No 9aType of entity (check only one box). Caution. If 8a is 223Yes,224 see the instructions for the correct box to check. Sole proprietor (SSN) Estate (SSN of decedent) Partnership Plan administrator (TIN) Corporation (enter form number to be filed) Trust (TIN of grantor) Personal service corporation Military/National Guard State/local government Church or church-controlled organization Farmers222 cooperative Federal government REMIC Indian tribal governments/enterprises Other (specify) Group Exemption Number (GEN) if any 9b If a corporation, name the state or foreign country (if applicable) where incorporated State Foreign country 10Reason for applying (check only one box) Banking purpose (specify purpose) Started new business (specify type) Changed type of organization (specify new type) Purchased going business Hired employees (Check the box and see line 13.) Created a trust (specify type) Compliance with IRS withholding regulations Created a pension plan (specify type) Other (specify) 11Date business started or acquired (month, day, year). See instructions. 12Closing month of accounting year 13 Highest number of employees expected in the next 12 months (enter -0- if none). If no employees expected, skip line 14.Agricultural Household Other 14If you expect your employment tax liability to be $1,000 or less in a full calendar year and want to file Form 944 annually instead of Forms 941 quarterly, check here. (Your employment tax liability generally will be $1,000 or less if you expect to pay $4,000 or less in total wages.) If you do not check this box, you must file Form 941 for every quarter. 15 16 Check one box that best describes the principal activity of your business. Health care & social assistance Wholesale-agent/broker Construction Rental & leasing Transportation & warehousing Accommodation & food service Wholesale-other Retail Real estate Manufacturing Finance & insurance Other (specify) 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 NoIf 223Yes,224 write previous EIN here Third Party Designee Complete this section only if you want to authorize the named individual to receive the entity222s EIN and answer questions about the completion of this form. Designee222s name Designee222s telephone number (include area code) Address and ZIP code Designee222s 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) Applicant222s telephone number (include area code)Signature Date Applicant222s fax number (include area code) For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Cat. No. 16055N Form SS-4 (Rev. 12-2017) Form SS-4 (Rev. 12-2017) Page 2 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 Does not currently have (nor expect to have) employees Complete lines 1, 2, 4a2268a, 8b226c (if applicable), 9a, 9b (if applicable), and 1022614 and 1622618. Hired (or will hire) employees, including household employees Does not already have an EIN Complete lines 1, 2, 4a2266, 7a226b (if applicable), 8a, 8b226c (if applicable), 9a, 9b (if applicable), 1022618. Opened a bank account Needs an EIN for banking purposes only Complete lines 12265b, 7a226b (if applicable), 8a, 8b226c (if applicable), 9a, 9b (if applicable), 10, and 18. Changed type of organization Either the legal character of the organization or its ownership changed (for example, you incorporate a sole proprietorship or form a partnership)2 Complete lines 122618 (as applicable). Purchased a going business3 Does not already have an EIN Complete lines 122618 (as applicable). Created a trust The trust is other than a grantor trust or an IRA trust4 Complete lines 122618 (as applicable). Created a pension plan as a plan administrator5 Needs an EIN for reporting purposes Complete lines 1, 3, 4a2265b, 9a, 10, and 18. Is a foreign person needing an EIN to comply with IRS withholding regulations Needs an EIN to complete a Form W-8 (other than Form W-8ECI), avoid withholding on portfolio assets, or claim tax treaty benefits6 Complete lines 12265b, 7a226b (SSN or ITIN optional), 8a, 8b226c (if applicable), 9a, 9b (if applicable), 10, and 18. Is administering an estate Needs an EIN to report estate income on Form 1041 Complete lines 12266, 9a, 1022612, 1322617 (if applicable), and 18. Is a withholding agent for taxes on non-wage income paid to an alien (i.e., individual, corporation, or partnership, etc.) 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 Complete lines 1, 2, 3 (if applicable), 4a2265b, 7a226b (if applicable), 8a, 8b226c (if applicable), 9a, 9b (if applicable), 10, and 18. Is a state or local agency Serves as a tax reporting agent for public assistance recipients under Rev. Proc. 80-4, 1980-1 C.B. 5817 Complete lines 1, 2, 4a2265b, 9a, 10, and 18. Is a single-member LLC (or similar single-member entity) Needs an EIN to file Form 8832, Classification Election, for filing employment tax returns and excise tax returns, or for state reporting purposes8, or is a foreign-owned U.S. disregarded entity and needs an EIN to file Form 5472, Information Return of a 25% Foreign-Owned U.S. Corporation or a Foreign Corporation Engaged in a U.S. Trade or Business (Under Sections 6038A and 6038C of the Internal Revenue Code) Complete lines 122618 (as applicable). Is an S corporation Needs an EIN to file Form 2553, Election by a Small Business Corporation9 Complete lines 122618 (as applicable).1 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 farmers222 cooperative must use an EIN for any tax-related purpose even if the entity does not have employees. 2 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). 3 Do not use the EIN of the prior business unless you becam