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Name of Business
*
Mailing Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Contact Person
*
First
Last
Email Address
*
Business Phone
*
Cell Phone
Email
*
Fax
Date Entity Formed
Federal Tax ID#
Type of Entity
*
Sole Prop
LLC
S Corp
C Corp
T/R
LLP
Trust
Other
Return Type to File
*
Sch C
Sch E
Sch F
T/R
1120
1120 S
1065
1041
Date of S-Corp acceptance (if applicable)
Entity Year End
Checkboxes
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
What your business does:
Method of Accounting
Cash
Accrual
Other (if other please explain below)
Comment
Name of each owner/shareholder, social security number or federal employer identification, number of shares/units and date issued:
Are there any foreign owners/shareholders?
*
Yes (If yes please identify above)
No
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