Fillable FORM E-9: COLLECTOR OF REVENUE - CITY OF (ADP)

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FORM E-9: COLLECTOR OF REVENUE - CITY OF (ADP)

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Country of origin: US
File type: PDF

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COLLECTOR OF REVENUE - CITY OF ST. LOUIS - APPLICATION FOR EARNINGS TAX ACCOUNT
Please type or print - send to Gregory F.X. Daly, Collector of Revenue, 1200 Market Street, Room 410, St. Louis, MO 63103
FORM E-9
REV. 07/13
Type of Organization: (Not for profit must supply copy of exemption certificate)Federal Employer ID Number or Social Security Number
Individual Business or Professional Person Partnership Corporation
Not for Profit Estate Other (specify)
Reason for applying: (check one)True Name
New Business
Purchased Business
Withholding for City Resident Only
Other (Specify)
Trade Name (Enter name if different than line above)
Telephone NumberCity, State, Zip Code
City, State, Zip Code
Address of Principal Place of Business
Local Telephone Number (If Different)Local Address (If different than above)
Date acquired or started within the city
of St. Louis:
Type of BusinessFirst date wages are to be paid:
Calendar Year
Fiscal Year Ending
H
ave you ever applied for an Earnings Tax Account for this or
any other business? Yes No (if Yes, enter FIDN or name)
Print or Type Name of Owner
/
Partner
/
Officer
Title
Date
Signature
Social Security Number
OFFICE USE ONLY:
DateApproved by
( )
( )
List All Partners or Corporate Officers (Attach list if necessary)
OFFICE USE ONLY
Name (Last, First, MI) Title
City, State, Zip
Home Address
Home Telephone NumberSocial Security Number
Name Title
City, State, ZipHome Address
Home Telephone NumberSocial Security Number
Name Title
City, State, ZipHome Address
Home Telephone NumberSocial Security Number
Name Title
City, State, Zip
Home Address
Home Telephone NumberSocial Security Number
Name Title
City, State, Zip
Home Address
Home Telephone NumberSocial Security Number
ALL INFORMATION SUBJECT TO VERIFICATION
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FORM E-9: COLLECTOR OF REVENUE - CITY OF (ADP)

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Completed 8 February 2021

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