,"'*$S'4
(Rev.December2017)
Departmentof theTreasury
lñternalRevenue
Serv¡ce
ldentificationNumber
Aoplicationfor Emplover
partnerships'
trusts' estates,churches,
OMB No. 1545-0003
¡pór
irse bv emplovers,corporátioné,
'governmént
and others,l
a!enbies,Indiantribalentities,certainindividuals,
for instructionsand the latest information'
} Go to www.irs.govlFormSS4
a copy for your records.
) See separate ¡nstructions for each line.
requested
idual)for whom the EINis
Legalname of entity
1
N T E R P R I S ELSL C
Tradenameof business(if ditferentfrom name on line 1)
¡
. administrator,trustee,"care of" name
(E
o
o +a lr¡ait¡nsáddress(room,apt., suite no. and street,or P.O.box)
c 1 O OT O W NC E N T E RC I R C L ES. T E .4 5 0
City, state,and ZIP code (¡fforeign,see instructions)
ct
A RATONF
. L3348ó
o
ness is located
o
and state where principal
o
7a
8a
8c
9a
City, state,and
ls this applicat¡onfor a limited liabilitycompany (LLC)
(or a foreignequivalent)?
Z Yus
!
tto
FOREIGN
8b lf 8a is "Yes," enter the number of
LLC members
|f8ais..Yes,''wastheLLCorganizedintheUnitedStates?
Type of entity (checkonly one box).Caurtion.lf 8a is "Yes," see the instructionsfor the correct box to check.
n Ert"t" (SSNof decedent)
n Sol" proprietor(SSN)
I Plunadministrator
[lN)
Ll Partnership
grantor)
of
Trust
)
Ü
filed)
fIlN
(enter
to
be
nr-¡mber
form
E Corporation
Guard n State/local governmenl
! Military/National
n Personalservicecorporation
n Farmers'cooperative n Federalgovernment
I Cfrurc¡ror church-controlledorganization
Indiankibalgovernments/enterprises
>
(specify)
organization
nonprofit
Number
lf a corporation,namethe state or foreigncountry (if
applicable)where incorporated
10
Reason for applying (checkonly one box)
n Sta*e¿ new business(specifytype)>
see line 13')
n Hiredemployees(Checkthe box and
regulat¡ons
withholding
with
IRS
Compliance
m
Foreigncountry
NEVIS
)
n Bankingpurpose(specifypurpose)
(specify
new type))
type
of
organization
Changed
n
u Purchasedgoing business >
(specifytyPe)
tr Created a trust
pensionplan (specifytype)>
ü
Createda
Other
Date businessstartedor acquired(month,day, year).See instructions'
-0- if none).
Highest numbef of employees expected in the next 12 months (enter
lf no employees expected, skip line 14.
Agricultural
n
n nevrc
9b
13
foreign,see
, lTlN,or EIN
Name of responsibleparty
n Oth"r
)
Other(specifu)
11
notentera P.O.box.)
address(if different)
Household
Other
Closingmonth of account¡ngYear D
lf you expectyour employmenttax liabilityto be $'1,000or
less in a full calendaryear and want to file Form944
annuallyinsteadof Forms941 quarterly'checkhere.
(Youremploymenttax liabilitygenerallywill be $1'000
or less if you expectto pay $4,000or less in total wages.)
lf vou do not check this box, you must file Form941 for
n
rj
income will first be paid to
First date wages or annuitieswere paid (month. day, year). Note: lf applicant is a withholding agent, enter date
)
N/A
nonresidentalien(month,day, yea0
--16CheckoneboXthatbestdescribeStheprincipa|"@rteanrrcare&socia|assiStancenwho|esale-agent/broker
nReta¡l
Iconstruction f] Rental&leasing Drr.nrpoi.t¡on&warehousingIAccommodation&foodservice Iwholesale-other
1s
n Realestate n Manufacturing tr
17
18
provided
Indicateprincipall¡neof merchandisesold, specif¡cconstructionwork done, products produced,or services
INVES]
I ves
Has the applicantentityshown on line 1 ever appliedfor and receivedan EIN?
EINhere )
of thisform'
aboutthecompletion
to receivetheentity'sEINandanswerquestions
thenamedinO¡v¡Oua
*ant to áuinorize
onlYif
thissection
Complete
Third
Party
Designee
telephonenumber{includeareacode)
Designee's
1) 361-2077
TZ POLLAC
clr?cLE
5 1 0 0l o w N C F - N l E f ?
Desionee'sfax number (includearea code)
Í?ATON,F
beliet,it is true, conect' and complete
Under penaltiesof perjurv,I declarethat I have examinedthis applicalion,and to th€ besl of my knowledgeand
Nanre and title
JHT]IZOGHI]I
712-6179
(include
areacode)
number
telephone
Applicant's
areacode)
fax number(include
Applicant's
S¡gnature
For Privacy
Act Notíce, see separate ¡nstructions.
cat. No.16055N
(Rev.12-2017)
