FR500 FR 500 042214
User Manual: FR500
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FR-500 GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF THE CHIEF FINANCIAL OFFICER OFFICE OF TAX AND REVENUE COMBINED REGISTRATION APPLICATION FOR BUSINESS DC TAXES/FEES/ASSESSMENTS • List of Principal Business Activity Codes (NAICS) • Instructions • Form FR-500 • General Information (Part I) • Franchise Tax Registration (Part II) • Employer’s DC Withholding Tax Registration (Part III) • Sales and Use Tax Registration (Part IV) • Personal Property Tax Registration (Part V, Section 1) • Ballpark Fee Registration (Part V, Section 2) • Nursing Facility Registration (Part V, Section 3) • Tobacco Products Excise Tax Registration (Part V, Section 4) • Intermediate Care Facility for Persons with Intellectual or Developmental Disabilities (ICF-IDD) Tax Registration (Part V, Section 5) • Hospital Revenue Assessment (Part V, Section 6) • Hospital Provider Fee (Part V, Section 7) • Miscellaneous Tax (Part V, Section 8) • Unemployment Compensation Tax Registration (Part VI) NOTE: Effective immediately, demographic information (Part 1, Line 13) is MANDATORY. Failure to complete this form in full may result in your denial for an application for a license or permit with other DC Government agencies. Corporations must provide Articles of Incorporation or Articles of Organization with the completed FR-500. Trade names must be first registered with the Department of Consumer and Regulatory Affairs (DCRA). OFFICE OF TAX AND REVENUE (OTR) CUSTOMER SERVICE ADMINISTRATION 1101 4TH STREET, SW Washington DC 20024 Telephone No. (202) 727-4TAX (4829) (Rev. 03/14) Codes for Principal Business Activity This list of principal business activities and their associated codes is designed to classify an enterprise by the type of activity in which it is engaged. These principal business activity codes are based on the North American Industry Classification System. Code Code Wood Product Manufacturing 321110 Sawmills & Wood Preservation 321210 Veneer, Plywood, & Engineered Wood Product Mfg 321900 Other Wood Product Mfg 333900 Other General Purpose Machinery Mfg Paper Manufacturing 322100 Pulp, Paper & Paperboard Mills 322200 Converted Paper Product Mfg If a company purchases raw materials and supplies them to a subcontractor to produce the finished product, but retains title to the product, the com- Printing and Related Support Activities pany is considered a manufacturer and must use one of the manufacturing 323100 Printing & Related Support codes (311110-339900). Activities Agriculture, Forestry, Fishing and Hunting Code Crop Production 111100 Oilseed & Grain Farming 111210 Vegetable & Melon Farming (including potatoes & yams) 111300 Fruit & Tree Nut Farming 111400 Greenhouse Nursery, & Floriculture Production 111900 Other Crop Farming (including tobacco, cotton, sugarcane, hay, peanut, sugar beet & all other crop farming) Animal Production 112111 Beef Cattle Ranching & Farming 112112 Cattle Feedlots 112120 Dairy Cattle & Milk Production 112210 Hog & Pig Farming 112300 Poultry & Egg Production 112400 Sheep & Goat Farming 112510 Animal Aquaculture (including shellfish & finfish farms & hatcheries) 112900 Other Animal Production Forestry and Logging 113110 Timber Tract Operations 113210 Forest Nurseries & Gathering of Forest Products 113310 Logging Fishing, Hunting and Trapping 114110 Fishing 114210 Hunting & Trapping Support Activities for Agriculture and Forestry 115110 Support Activities for Crop Production (including cotton ginning, soil preparation, planting & cultivating) 115210 Support Activities for Animal Production 115310 Support Activities for Forestry Mining 211110 212110 212200 212310 212320 Oil & Gas Extraction Coal Mining Metal Ore Mining Stone Mining & Quarrying Sand, Gravel, Clay, & Ceramic & Refractory Minerals Mining & Quarrying 212390 Other Nonmetallic Mineral Mining & Quarrying 213110 Support Activities for Mining Utilities 221100 Electric Power Generation, Transmission & Distribution 221210 Natural Gas Distribution 221300 Water, Sewage & Other Systems Construction Building, Developing, and General Contracting 233110 Land Subdivision & Land Development Petroleum and Coal Products Manufacturing 324100 Petroleum Refineries (including integrated) 324120 Asphalt Paving, Roofing, & Saturated Materials Mfg 324190 Other Petroleum & Coal Products Mfg Code 233200 Residential Building Construction 233300 Nonresidential Building Construction Heavy Construction 234100 Highway, Street, Bridge, & Tunnel Construction 234900 Other Heavy Construction Chemical Manufacturing 325100 Basic Chemical Mfg 325200 Resin, Synthetic Rubber & Artificial & Synthetic Fibers & Filaments Mfg 325300 Pesticide, Fertilizer, & Other Agricultural Chemical Mfg 325410 Pharmaceutical & Medicine Mfg 325500 Paint Coating, & Adhesive Mfg 325600 Soap, Cleaning Compound, & Toilet Preparation Mfg 325900 Other Chemical Product & Preparation Mfg Special Trade Contractors 235110 Plumbing, Heating, & Air-Conditioning Contractors 235210 Painting & Wall Covering Contractors 235310 Electrical Contractors 235400 Masonry, Drywall, Insulation, & Tile Contractors 235500 Carpentry & Floor Contractors 235610 Roofing, Siding, & Sheet Metal Contractors 235710 Concrete Contractors 235810 Water Well Drilling Contractors 235900 Other Special Trade Contractors Plastics and Rubber Products Manufacturing 326100 Plastics Product Mfg 326200 Rubber Product Mfg Nonmetallic Mineral Product Manufacturing 327100 Clay Product & Refractory Mfg 327210 Glass & Glass Product Mfg 327300 Cement & Concrete Product Mfg 327400 Lime & Gypsum Product Mfg 327900 Other Nonmetallic Mineral Product Mfg Manufacturing Food Manufacturing 311110 Animal Food Mfg 311200 Grain & Oilseed Milling 311300 Sugar & Confectionery Product Mfg 311400 Fruit & Vegetable Preserving & Specialty Food Mfg 311500 Dairy Product Mfg 311610 Animal Slaughtering and Processing 311710 Seafood Product Preparation & Packaging 311800 Bakeries & Tortilla Mfg 311900 Other Food Mfg (including coffee, tea, flavorings & seasonings) Primary Metal Manufacturing 331110 Iron & Steel Mills & Ferroalloy Mfg 331200 Steel Product Mfg from Purchased Steel 331310 Alumina & Aluminum Production & Processing 331400 Nonferrous Metal (except Aluminum) Production & Processing 331500 Foundries Beverage and Tobacco Product Manufacturing 312110 Soft Drink & Ice Mfg 312120 Breweries 312130 Wineries 312140 Distilleries 312200 Tobacco Manufacturing Fabricated Metal Product Manufacturing 332110 Forging & Stamping 332210 Cutlery & Handtool Mfg 332300 Architectural & Structural Metals Mfg 332400 Boiler, Tank, & Shipping Container Mfg 332510 Hardware Mfg 332610 Spring & Wire Product Mfg 332700 Machine Shops; Turned Product; & Screw, Nut, & Bolt Mfg 332810 Coating, Engraving, Heat Treating, & Allied Activities 332900 Other Fabricated Metal Product Mfg Textile Mills and Textile Product Mills 313000 Textile Mills 314000 Textile Product Mills Apparel Manufacturing 315100 Apparel Knitting Mills 315210 Cut & Sew Apparel Contractors 315220 Men’s & Boys’ Cut & Sew Apparel Mfg 315230 Women’s & Girls’ Cut & Sew Apparel Mfg 315290 Other Cut & Sew Apparel mfg 315990 Apparel Accessories & Other Apparel Mfg Machinery Manufacturing 333100 Agriculture, Construction, & Mining Machinery Mfg 333200 Industrial Machinery Mfg 333310 Commercial & Service Industry Machinery Mfg 333410 Ventilation, Heating, AirConditioning, & Commercial Refrigeration Equipment Mfg 333510 Metalworking Machinery Mfg 333610 Engine, Turbine & Power Transmission Equipment Mfg Leather and Allied Product Manufacturing 316110 Leather & Hide Tanning & Finishing 316210 Footwear Mfg (including rubber & plastics) 316990 Other Leather & Allied Product Mfg 1 Computer and Electronic Product Manufacturing 334110 Computer & Peripheral Equipment Mfg 334200 Communications Equipment Mfg 334310 Audio & Video Equipment Mfg 334410 Semiconductor & Other Electronic Component Mfg 334500 Navigational, Measuring, Electromedical, & Control Instruments Mfg 334610 Manufacturing & Reproducing Magnetic & Optical Media Electrical Equipment, Appliance, and Component Manufacturing 335100 Electric Lighting Equipment Mfg 335200 Household Appliance Mfg 335310 Electrical Equipment Mfg 335900 Other Electrical Equipment & Component Mfg Transportation Equipment Manufacturing 336100 Motor Vehicle Mfg 336210 Motor Vehicle Body & Trailer Mfg 336300 Motor Vehicle Parts Mfg 336410 Aerospace Product & Parts Mfg 336510 Railroad Rolling Stock Mfg 336610 Ship & Boat Building 336990 Other Transportation Equipment Mfg Furniture and Related Product Manufacturing 337000 Furniture & Related Product Manufacturing Miscellaneous Manufacturing 339110 Medical Equipment & Supplies Mfg 339900 Other Miscellaneous Manufacturing Wholesale Trade Wholesale Trade, Durable Goods 421100 Motor Vehicle & Motor Vehicle Parts & Supplies Wholesalers 421200 Furniture & Home Furnishing Wholesalers 421300 Lumber & Other Construction Materials Wholesalers 421400 Professional & Commercial Equipment & Supplies Wholesalers 421500 Metal & Mineral (except Petroleum) Wholesalers 421600 Electrical Goods Wholesalers 421700 Hardware, & Plumbing & Heating Equipment & Supplies Wholesalers 421800 Machinery, Equipment, & Supplies Wholesalers 421910 Sporting & Recreational Goods & Supplies Wholesalers 421920 Toy & Hobby Goods & Supplies Wholesalers 421930 Recyclable Material Wholesalers 421940 Jewelry, Watch, Precious Stone, & Precious Metal Wholesalers 421990 Other Miscellaneous Durable Goods Wholesalers 422100 Paper & Paper Product Wholesalers 422210 Drugs & Druggists’ Sundries Wholesalers 422300 Apparel, Piece Goods, & Notions Wholesalers 422400 Grocery & Related Product Wholesalers 422500 Farm Products Raw Material Wholesalers 422600 Chemical & Allied Products Wholesalers Code Code Code Code Wholesale Trade, Durable Goods 422700 Petroleum & Petroleum Products Wholesalers 422800 Beer, Wine, & Distilled Alcoholic Beverage Wholesalers 422910 Farm Supplies Wholesalers 422920 Books, Periodical, & Newspaper Wholesalers 422930 Flower, Nursery Stock & Florists’ Supplies Wholesalers 422940 Tobacco & Tobacco Product Wholesalers 422950 Paint, Varnish, & Supplies Wholesalers 422990 Other Miscellaneous Nondurable Goods Wholesalers Sporting Goods, Hobby, Book, and Music Stores 451110 Sporting Goods Stores 451120 Hobby, Toy, & Game Stores 451130 Sewing, Needlework, & Piece Goods Stores 451140 Musical Instrument & Supplies Stores 451211 Book Stores 451212 News Dealers & Newsstands 451220 Prerecorded Tape, Compact Disc, & Record Stores 488990 Other Support Activities for Transportation Insurance Carriers and Related Activities 524140 Direct Life, Health, & Medical Insurance & Reinsurance Carriers 524150 Direct Insurance & Reinsurance (except Life, Health & Medical) Carriers 524210 Insurance Agencies & Brokerages 524290 Other Insurance Related Activities General Merchandise Stores 452110 Department Stores 452900 Other General Merchandise Stores Information Retail Trade Miscellaneous Store Retailers 453110 Florists 453210 Office Supplies & Stationery Stores 453220 Gift, Novelty, & Souvenir Stores 453310 Used Merchandise Stores 453910 Pet & Pet Supplies Stores 453920 Art Dealers 453930 Manufactured (Mobile) Home Dealers 453990 All Other Miscellaneous Store Retailers (including tobacco, candle, & trophy shops) Motor Vehicle and Parts Dealers 441110 New Car Dealers 441120 Used Car Dealers 441210 Recreational Vehicle Dealers 441221 Motorcycle Dealers 441222 Boat Dealers 441229 All Other Motor Vehicle Dealers 441300 Automotive Parts, Accessories, & Tire Stores Furniture and Home Furnishings Stores 442110 Furniture Stores 442210 Floor Covering Stores 442291 Window Treatment Stores 442299 All Other Home Furnishings Stores Electronics and Appliance Stores 443111 Household Appliance Stores 443112 Radio, Television, & Other Electronics Stores 443120 Computer & Software Stores 443130 Camera & Photographic Supplies Stores Building Material and Garden Equipment and Supplies Dealers 444110 Home Centers 444120 Paint & Wallpaper Stores 444130 Hardware Stores 444190 Other Building Material Dealers 444200 Lawn & Garden Equipment & Supplies Stores Food and Beverage Stores 445110 Supermarkets and Other Grocery (except Convenience) Stores 445120 Convenience Stores 445210 Meat Markets 445220 Fish & Seafood Markets 445230 Fruit & Vegetable Markets 445291 Baked Goods Stores 445292 Confectionery & Nut Stores 445299 All Other Specialty Food Stores 445310 Beer, Wine, & Liquor Stores Health and Personal Care Stores 446110 Pharmacies & Drug Stores 446120 Cosmetics, Beauty Supplies, & Perfume Stores 446130 Optical Goods Stores 446190 Other Health & Personal Care Stores Gasoline Stations 447100 Gasoline Stations (including convenience stores with gas) Clothing and Clothing Accessories Stores 448110 Men’s Clothing Stores 448120 Women’s Clothing Stores 448130 Children’s & Infants’ Clothing Stores 448140 Family Clothing Stores 448150 Clothing Accessories Stores 448190 Other Clothing Stores 448219 Shoe Stores 448310 Jewelry Stores 448320 Luggage & Leather Goods Stores Couriers and Messengers 492110 Couriers 492210 Local Messengers & Local Delivery Warehousing And Storage 493100 Warehousing & Storage (except lessors of miniwarehouses & self-storage units) Publishing Industries 511110 Newspaper Publishers 511120 Periodical Publishers 511130 Book Publishers 511140 Database & Directory Publishers 511190 Other Publishers 511210 Software Publishers Motion Picture and Sound Recording Industries 512100 Motion Picture & Video Industries (except video rental) 512200 Sound Recording Industries Broadcasting and Telecommunications 513100 Radio & Television Broadcasting 513200 Cable Networks & Program Distribution 513300 Telecommunications (including paging, cellular, satellite, & other telecommunications) Nonstore Retailers 454110 Electronic Shopping & MailOrder Houses 454210 Vending Machine Operators 454311 Heating Oil Dealers 454312 Liquefied Petroleum Gas (Bottled Gas) Dealers 454319 Other Fuel Dealers 454390 Other Direct Selling Establishments (including doorto-door retailing, frozen food plan providers, party plan merchandisers, & coffee-break service providers) Information Services and Data Processing Services 514100 Information Services (including news syndicates, libraries, & on-line information services) 514210 Data Processing Services Finance and Insurance Depository Credit Intermediation 522110 Commercial Banking 522120 Savings Institutions 522130 Credit Unions 522190 Other Depository Credit Intermediation Transportation and Warehousing Air, Rail, and Water Transportation 481000 Air Transportation 482110 Rail Transportation 483000 Water Transportation Truck Transportation 484110 General Freight Trucking, Local 484120 General Freight Trucking, Longdistance 484200 Specialized Freight Trucking Nondepository Credit Intermediation 522210 Credit Card Issuing 522220 Sales Financing 522291 Consumer Lending 522292 Real Estate Credit (including mortgage bankers & originators) 522293 International Trade Financing 522294 Secondary Market Financing 522298 All Other Nondepository Credit Intermediation Transit and Ground Passenger Transportation 485110 Urban Transit Systems 485210 Interurban & Rural Bus Transportation 485310 Taxi Service 485320 Limousine Service 485410 School & Employee Bus Transportation 485510 Charter Bus Industry 485990 Other Transit & Ground Passenger Transportation Activities Related to Credit Intermediation 522300 Activities Related to Credit Intermediation (including loan brokers) Securities, Commodity Contracts, and Other Financial Investments and Related Activities 523110 Investment Banking & Securities Dealing 523120 Securities Brokerage 523130 Commodity Contracts Dealing 523140 Commodity Contracts Brokerage 523210 Securities & Commodity Exchanges 523900 Other Financial Investment Activities (including portfolio management & investment advice) Pipeline Transportation 486000 Pipeline Transportation Scenic & Sightseeing Transportation 487000 Scenic & Sightseeing Transportation Support Activities for Transportation 488100 Support Activities for Air Transportation 488210 Support Activities for Rail Transportation 488300 Support Activities for Water Transportation 488410 Motor Vehicle Towing 488490 Other Support Activities for Road Transportation 488510 Freight Transportation Arrangement 2 Funds, Trusts, and Other Financial Vehicles 525100 Insurance & Employee Benefit Funds 525910 Open-end Investment Funds 525920 Trusts, Estates, & Agency Accounts 525930 Real Estate Investment Trusts 525990 Other Financial Vehicles “Offices of Bank Holding Companies” and “Offices of Other Holding Companies,” are located under Management of Companies (Holding Companies) Real Estate and Rental and Leasing Real Estate 531110 Lessors of Residential Buildings & Dwellings 531114 Cooperative Housing 531120 Lessors of Miniwarehouses & Self-Storage Units 531190 Lessors of Other Real Estate Property 531210 Offices of Real Estate Agents & Brokers 531310 Real Estate Property Managers 531320 Offices of Real Estate Appraisers 531390 Other Activities Related to Real Estate Rental and Leasing Services 532100 Automotive Equipment Rental & Leasing 532210 Consumer Electronics & Appliances Rental 532220 Formal Wear & Costume Rental 532230 Video Tape & Disc Rental 532290 Other Consumer Goods Rental 532310 General Rental Centers 532400 Commercial & Industrial Machinery & Equipment Rental & Leasing Lessors of Nonfinancial Intangible Assets (except copyrighted works) 533110 Lessors of Nonfinancial Intangible Assets (except copyrighted works) Professional, Scientific, and Technical Services Legal Services 541110 Offices of Lawyers 541190 Other Legal Services Accounting, Tax Preparation, Bookkeeping, and Payroll Services 541211 Offices of Certified Public Accountants 541213 Tax Preparation Services 541214 Payroll Services 541219 Other Accounting Services Architectural, Engineering, and Related Services 541310 Architectural Services 541320 Landscape Architecture Services 541330 Engineering Services 541340 Drafting Services Code Code Code Code Architectural Engineering, and Related Services 541350 Building Inspection Services 541360 Geophysical Surveying & Mapping Services 541370 Surveying & Mapping (except Geophysical) Services 541380 Testing Laboratories 561500 Travel Arrangement & Reservation Services 561600 Investigation & Security Services 561710 Exterminating & Pest Control Services 561720 Janitorial Services 561730 Landscaping Services 561740 Carpet & Upholstery Cleaning Services 561790 Other Services to Buildings & Dwellings 561900 Other Support Services (including packaging & labeling services, & convention & trade show organizers) Other Ambulatory Health Care Services 621900 Other Ambulatory Health Care Services (including ambulance services & blood & organ banks) Food Services and Drinking Places 722110 Full-Service Restaurants 722210 Limited-Service Eating Places 722300 Special Food Services (including food service contractors & caterers) 722330 Mobile Food Vendors Including Trucks and Hot Dog Carts 722410 Drinking Places (Alcoholic Beverages) Specialized Design Services 541400 Specialized Design Services (including interior, industrial, graphic, & fashion design) Computer Systems Design and Related Services 541511 Custom Computer Programming Services 541512 Computer Systems Design Services 541513 Computer Facilities Management Services 541519 Other Computer Related Services Other Professional, Scientific, and Technical Services 541600 Management, Scientific, & Technical Consulting Services 541700 Scientific Research & Development Services 541800 Advertising & Related Services 541910 Marketing Research & Public Opinion Polling 541920 Photographic Services 541930 Translation & Interpretation Services 541940 Veterinary Services 541990 All Other Professional, Scientific, & Technical Services Management of Companies (Holding Companies) 551111 Offices of Bank Holding Companies 551112 Offices of Other Holding Companies Administrative and Support and Waste Management and Remediation Services Administrative and Support Services 561110 Office Administrative Services 561210 Facilities Support Services 561300 Employment Services 561410 Document Preparation Services 561420 Telephone Call Centers 561430 Business Service Centers (including private mail centers & copy shops) 561440 Collection Agencies 561450 Credit Bureaus 561490 Other Business Support Services (including repossession services, court reporting, & stenotype services) Hospitals 622000 Hospitals Nursing and Residential Care Facilities 623000 Nursing & Residential Care Facilities Social Assistance 624100 Individual & Family Services 624200 Community Food & Housing, & Emergency & Other Relief Services 624310 Vocational Rehabilitation Services 624410 Child Day Care Services Waste Management and Remediation Services 562000 Waste Management & Remediation Services Educational Services Arts, Entertainment, and Recreation 611000 Educational Services (including schools, colleges, & universities) Performing Arts, Spectator Sports, and Related Industries 711100 Performing Arts Companies 711210 Spectator Sports (including sports clubs & racetracks) 711300 Promoters of Performing Arts, Sports, & Similar Events 711410 Agents & Managers for Artists, Athletes, Entertainers & Other Public Figures 711510 Independent Artists, Writers, & Performers Health Care and Social Assistance Offices of Physicians and Dentists 621111 Offices of Physicians (except mental health specialists) 621112 Offices of Physicians, mental Health Specialists 621210 Office of Dentists Offices 621310 621320 621330 of Other Health Practitioners Offices of Chiropractors Offices of Optometrists Offices of Mental Health Practitioners (except Physicians) 621340 Offices of Physical, Occupational & Speech Therapists, & Audiologists 621391 Offices of Podiatrists 621399 Offices of All Other Miscellaneous Health Practitioners Museums, Historical Sites, and Similar Institutions 712100 Museums, Historical Sites & Similar Institutions Amusement, Gambling, and Recreation Industries 713100 Amusement Parks & Arcades 713200 Gambling Industries 713900 Other Amusement & Recreation Industries (including golf courses, skiing facilities, marinas, fitness centers, & bowling centers) Outpatient Care Centers 621410 Family Planning Centers 621420 Outpatient Mental Health & Substance Abuse Centers 621491 HMO Medical Centers 621492 Kidney Dialysis Centers 621493 Freestanding Ambulatory Surgical & Emergency Centers 621498 All Other Outpatient Care Centers Accommodations and Food Services Accommodations 721110 Hotels (except casino hotels) & Motels 721120 Casino Hotels 721191 Bed & Breakfast Inns 721199 All Other Traveler Accommodation 721210 RV (Recreational Vehicle) Parks & Recreational Camps 721310 Rooming & Boarding Houses Medical and Diagnostic Laboratories 621510 Medical & Diagnostic Laboratories Home Health Care Services 621610 Home Health Care Services Other Services Repair and Maintenance 811110 Automotive Mechanical & Electrical Repair & Maintenance 811120 Automotive Body, Paint, Interior, & Glass Repair 811190 Other Automotive Repair & Maintenance (including oil change & lubrication shops & car washes) 811210 Electronic & Precision Equipment Repair & Maintenance 811310 Commercial & Industrial Machinery & Equipment (except Automotive & Electronic) Repair & Maintenance 811410 Home & Garden Equipment & Appliance Repair & Maintenance 811420 Reupholstery & Furniture Repair 811430 Footwear & Leather Goods Repair 811490 Other Personal & Household Goods Repair & Maintenance Personal and Laundry Services 812111 Barber Shops 812112 Beauty Salons 812113 Nail Salons 812190 Other Personal Care Services (including diet & weight reducing centers) 812210 Funeral Homes & Funeral Services 812220 Cemeteries & Crematories 812310 Coin-Operated Laundries & Drycleaners 812320 Drycleaning & Laundry Services (except CoinOperated) 812330 Linen & Uniform Supply 812910 Pet Care (except Veterinary) Services 812920 Photofinishing 812930 Parking Lots & Garages 812990 All Other Personal Services Religious, Grantmaking, Civic, Professional, and Similar Organizations 813000 Religious, Grantmaking, Civic, Professional, & Similar Organizations (including condominium and homeowners associations) Additional codes can be found at http://www.census.gov/eos/www/naics/ 3 4 INSTRUCTIONS The Combined Registration Application For Business DC Taxes/Fees/Assessments (Form FR-500) is to be completed by a business or consumer registering with the Government of the District of Columbia (DC), Office of Tax and Revenue (OTR) and the Department of Employment Services (DOES) for the following taxes or payment: • Corporation Franchise Tax Return (Form D-20) • Unincorporated Business Franchise Tax Return (Form D-30) • Employer Withholding Tax Return (Form FR-900 series) • Sales and Use Tax Return (Form FR-800 series) • Personal Property Tax Return (Form FP-31) • Ballpark Fee • Tobacco Products Excise Tax • Department of Health Care Finance Assessments/Fees (DHCF) • Miscellaneous Tax • Unemployment Compensation Tax (Registered by DOES) GENERAL INSTRUCTIONS The following general instructions will assist you in completing Form FR-500. • Furnish all information requested in Parts I through VI. If not applicable, write “N/A” in the answer block. • Effective immediately, demographic information (Part I, Line 13) is mandatory. • Although there is some duplication of information requested in Part I and Part VI, both parts must be completed. Part VI is processed separately from Parts I through V-1 and V-2. • Answer all questions requesting a date with the month, day and year. • Sign the application at the end of Parts V-7 and VI. • Return only the signed, original, completed application form, DO NOT SEND COPIES. PART I • Enter your Federal Employer Identification Number. • Enter your Social Security Number. • Enter the correct Business Activity Code from the list of codes provided. The identification number(s) entered on the Form FR-500 will be used only for tax administration purposes. PART II DC TAX REQUIREMENTS Partnership Return of Income (D-65) — Partnerships not required to file a Form D-30 (for whatever reason) must file a Form D-65. Non-profit Organizations — Organizations subject to tax on unrelated business income, as defined in IRC §512, must file a Form D-20, Corporation Franchise Tax return. The due date for this filing is the 15th day of the fifth month after the close of the organization’s tax year. PART III Employer Withholding Tax Employer Withholding Tax — Every employer who pays wages to a DC resident or payor of lump-sum distributions who withholds DC income tax must file a DC withholding tax return. This includes individual employers who have household employee(s). Lump-sum distributions do not include: (a) any portion of a lump-sum payment that was previously subject to tax; (b) an eligible rollover distribution that is effected as a direct trustee to trustee transfer; and (c) a rollover from an individual retirement account to a traditional or Roth individual retirement account that is affected as a direct trustee to trustee transfer. An employer or payor who fails to withhold or pay withholding taxes to DC is personally liable for the tax. If your withholding tax liability is less than or equal to $200 per period, file an annual return, FR-900A. The FR-900A is due on or before the 20th day of January following the year being reported. If your withholding tax liability is greater than or equal to $201 and less than or equal to $1200 per period, file a quarter return, FR-900Q. The FR-900Q is due on or before the 20th day of the month following the quarter being reported. If your withholding tax liability is greater than or equal to $1201 per period, file a monthly return, FR-900M. The FR-900M is due on or before the 20th day of the month following the month being reported. The District requires withholding at the highest DC income tax rate (8.95%) for DC residents on lump-sum distributions from retirement accounts and plans. Note: If your withholding tax liability is $5,000 or greater per period, you shall file and pay electronically. Visit www.taxpayerservicecenter.com Corporation Franchise Tax Unincorporated Business Franchise Tax PART IV Sales and Use Tax Corporation Franchise Tax — Every corporation engaging in or carrying on a trade or business in DC and/or receiving income from sources within DC must file a Corporation Franchise Tax Return (Form D-20). The return must be filed by March 15th or the 15th day of the third month following the close of the corporation’s taxable year. If the amount of DC Gross Receipts owed is less than the $250 minimum required payment, $250 must be paid. Sales Tax — Every sales vendor, mobile food services vendor and Business Beneficial License Holder (BBLH) who has made any sale at retail taxable under the provisions of District of Columbia (DC) Official Code §47-2001 et seq., shall file a return with the OTR. Such returns shall show the total gross proceeds of the vendor's business for the month, quarter or year for which the return is filed; the gross receipts of the business of the vendor upon which the tax is computed; the amount of tax for which the vendor is liable and such other information that is deemed necessary for the computation and collection of the tax. If your sales and use liability is less than or equal to $200 per period, file an annual return, FR-800A. The FR-800A is due on or before October 20th. If your sales and use tax liability is greater than or equal to $201 and less than or equal to $1200 per period, file a quarterly return, FR-800Q. The FR-800Q is due on or before the 20th day of the month following the quarter being reported. If your sales and use tax liability is greater than or equal to $1201 per period, file a monthly return, FR-800M. The FR-800M is due on or before the 20th day of the month following the month being reported. Unincorporated Business Franchise Tax — An Unincorporated Business Franchise Tax Return (Form D-30) is required of every unincorporated business (sole proprietor, joint venture, etc.) engaging in or carrying on a trade or business in DC, deriving rental income, and/or receiving other income from sources within DC, whose gross receipts exceed $12,000. A Form D-30 must be filed by April 15th or the 15th day of the fourth month following the close of the business taxable year. The minimum tax is $1,000 for corporate and unincorporated filers with District gross receipts greater than $1 million. 5 owned on July 1st. Also, every railroad company whose lines run through DC, must report by July 31st of each year, on Form FP-33 (Railroad Company Report), and any other company whose cars run on their DC tracks, must file Form FP-34 (Rolling Stock Tax Return) together with full payment of the tax owed. The promoter of a Special Event must provide a list of the participants (the individuals who must collect DC sales tax from the purchasers of any goods sold at the event). The list should contain the name, address and telephone number of each participant, the name and date(s) of the event. Please refer to the Special Event Registration Application (Form FR-500B) for additional information. Note: If your personal property tax liability is $5,000 or greater, you shall file and pay electronically. Visit www.taxpayerservicecenter.com The Sales and Use Tax Special Event Return, Form FR-800SE, is used to report and pay any sales and use tax liability arising from a special event. It is due by the 20th of the month following the last day of the special event. PART V, Section 2 Ballpark Fee Except as provided below, any person that derived at least $5 million in annual District gross receipts and who was subject to any of the following at any given point during that person’s most recent calendar or fiscal year ending on or before June 15th, each year, shall file and pay the Ballpark Fee online: • DC Corporation Franchise Tax; • DC Unincorporated Business Franchise Tax; or • The DC Unemployment Compensation Act, except employers who employ persons to provide personal or domestic services in a private home unless the employment is in relation to the employer’s trade, occupation, profession, enterprise or vocation. A $.05 fee is imposed on each disposable carryout bag provided by retail establishments - grocery stores, drug stores, liquor stores, restaurants and food vendors (including street vendors) - to their customers. Street and Mobile Food Services Vendor Minimum Sales Tax (FR-800V) Vendor Sales Tax Collection and Remittance Act of 2012 requires a minimum sales tax that a street or mobile food services vendor (a person licensed to vend from a sidewalk, roadway, or other public space) must file and pay in lieu of the previous “payment in lieu of collecting and remitting sales tax”. Street and mobile food services vendors are required to collect sales tax and file and pay a street vendor minimum sales tax (MST) quarterly tax return and remit the greater of the taxes collected (5.75% or 10%) or the minimum sales tax of $375 on a quarterly basis. PART V, Section 3 Nursing Facility Assessment The nursing facility assessment liability is set annually on a fiscal year basis, ending September 30th. Every nursing care provider operating in the District must pay the nursing facility assessment. Nursing care providers operated by the federal government are exempt. The assessment can only be filed and paid online. Use Tax — The use tax is imposed at the same rate as the corresponding sales tax on the purchase or rental of tangible personal property for the use, storage or consumption in DC by a buyer who did not pay a sales tax to DC or any other tax jurisdiction at the time of the purchase or rental of the property. PART V, Section 4 Tobacco Products Excise Tax Employer Use Tax Return Act of 2012 Any employer required to file a DC withholding tax return, which is not otherwise required to collect and remit sales tax, shall file an annual use tax return on or before October 20th of each year, remitting with such return the use taxes which are due. Business must pay the tobacco products excise tax every quarter to report ‘little cigars’ and other tobacco products sold in the District during the reporting period using Form FR-1000Q. PART V, Section 5 Intermediate Care Facility for Persons with Intellectual or Developmental Disabilities (ICF-IDD) Note: If your sales tax liability is $5,000 or greater, you shall file and pay electronically. Visit www.taxpayerservicecenter.com Every ICF-IDD facility operating in the District must pay the ICF-IDD assessment in quarterly installments. The assessment can only be filed and paid online. PART V, Section 1 Personal Property Tax Personal Property Tax — A Personal Property Tax Return (Form FP-31) must be filed by every business owning or holding in trust any tangible personal property (furniture, computers, fixtures, books, etc.) located in or having a taxable situs in DC. The tax applies to property used or available for use in a trade, business or office held for business purposes, including property kept in storage or held for rent or which is leased to third parties, including governmental agencies, under a “lease-purchase agreement.” A Form FP-31 must be filed and the tax paid on or before July 31st of each year based upon the remaining cost (current value) of all tangible personal property owned as of July 1st. PART V, Section 6 Hospital Revenue Assessment Annually, by September 1, each hospital operating in the District must pay the assessment. The assessment can only be filed and paid online. PART V, Section 7 Hospital Provider Fee Each hospital operating in the District must pay the hospital provider fee quarterly, due the 15th day of the District's fiscal year quarter (Dec., Mar., June and Sept.) The fee can only be filed and paid online. Railroad companies operating rolling stock, parlor cars and sleeping cars in DC over any railroad line, must file Form FP-32 (Railroad Tangible Property Return) by July 31st of each year, on property If you have any questions regarding these tax requirements, contact the Office of Tax and Revenue, Customer Service Administration, 1101 4th Street, SW, Washington, DC 20024; or call (202) 727-4TAX (4829). First time applicants must mail the original application to: Office of Tax and Revenue, Customer Service Administration, PO Box 470, Washington, DC 20044-0470. 6 Part V, Section 8 Miscellaneous Tax Gross Receipts Tax — Utilities, telecommunication companies providing long distance service, companies providing cable television, satellite relay or distribution of video or radio transmission to subscribers and paying customers, heating oil delivery companies, commercial mobile service providers and non-public utility sellers of natural or artificial gas are subject to a Gross Receipts Tax. Companies subject to the Gross Receipts Tax must submit a monthly report of their gross receipts from DC sources. Gross receipts are reported by filing: Form FP-27 for utilities; Form FP-27T for toll telecommunication companies; Form FP-27C for cable television, satellite relay, or distribution of video and radio transmission companies; Form FP-27NAG for non-public utility sellers of natural or artificial gas; Form FP-27M for commercial mobile service providers; or Form FP-27H for heating oil delivery companies. Companies must file the proper form by the 20th of the month following the month being reported. If you have any questions regarding these tax requirements, contact the Office of Tax and Revenue, Customer Service Administration, 1101 4th Street, SW, Washington, DC 20024; or call (202) 727-4TAX (4829). First time applicants must mail the original application to: Office of Tax and Revenue, Customer Service Administration, PO Box 470, Washington, DC 20044-0470 7 PART VI UNEMPLOYMENT COMPENSATION TAX REGISTRATION COMPLETE PART VI ONLY IF YOU HAVE EMPLOYEES WHO WORK IN THE DISTRICT OF COLUMBIA. Although some information has already been requested in Part 1, this form must be completed in its entirely by all employers who have employees working in the District of Columbia. PART VI will be processed separately from Parts I through V. If you have any questions or need additional information regarding PART VI, please call the DC Department of Employment Services Office of Unemployment Compensation-Tax Division at 202-698-7550 All items marked "REQUIRED" must be completed. Failure to complete the required items will delay the processing of the registration. Unemployment Compensation Tax — Employers who hire one or more persons to perform services in DC must register for Unemployment Compensation Taxes. Domestic/ household employers who pay cash remuneration of $500 or more in any calendar quarter also must register and file reports. A non-profit organization granted an exemption from the payment of FUTA taxes under IRC §501(c)(3) may elect to reimburse the DC Office of Unemployment Compensation instead of paying taxes. PERCENTAGE OF ASSETS ACQUIRED. Enter the appropriate information in Item 15 of Part VI of the form. List any prior DC ID number issued to you or to the business. If you are a new employer acquiring your business from a predecessor, answer the appropriate questions or state whether this is a change in the entity doing business under individual ownership, partnership or corporation. This information is necessary to determine your experience rate. If changing the trade name, include the former trade name. ITEM 16 OF PART VI SHOULD ONLY BE COMPLETED BY NONPROFIT ORGANIZATIONS. If the organization is exempt from federal unemployment taxes, check the appropriate box and include a copy of the Internal Revenue Service exemption letter. Questions concerning liability or financing options for Unemployment Compensation Taxes should be directed to the DC Department of Employment Services, Office of Unemployment Compensation, Tax Division, 4058 Minnesota Ave., NE, 4th FL, Washington, DC 20019 or telephone (202) 698-7550. The facsimile number is (202) 698-5706. A non-profit organization has two options for financing Unemployment Insurance Coverage: 1. Paying contributions at the rate assigned by the DC Department of Employment Services. The rate is applied to the taxable wages earned by each employee during a calendar year. Contributions are paid on a calendar quarter basis. 2. Reimburse the trust fund. At the end of each calendar quarter, the employer is billed for unemployment benefits paid by DC to its former employees during the quarter. Please note that entities completing this form as a requirement for submitting contract proposals with the Government of the District of Columbia MUST complete this form even if they do not have employees who work in the District of Columbia. 8 FR-500 COMBINED REGISTRATION APPLICATION FOR BUSINESS DC TAXES/FEES/ASSESSMENTS GOVERNMENT OF THE DISTRICT OF COLUMBIA OFFICE OF TAX AND REVENUE PART I — General Information ■■ – ■■■■■■ ■■■■■■■ ■ ■■■ – ■■ – ■■■■ 1(a). Federal Employer Identification Number 1(b). Social Security Number 2. NAICS Business Code ■■■■■■ 3. Reason for application: (please check) 4. Legal form of business (please check): ❏ New business ❏ Employment of household/domestic help ❏ Sole Proprietor ❏ Limited partnership ❏ Additional location ❏ Address change ❏ Limited Liability Company ❏ Government ❏ Purchased existing business ❏ Merger (attach merger agreement) ❏ General partnership ❏ Joint Venture ❏ Name change ❏ Other (describe on an attachment) ❏ Limited Liability Partnership ❏ Other (specify) (if a corporation, attach corporation amendment) ❏ Heating oil company ❏ Corporation ❏ Legal form change ❏ Utility company Mandatory: If incorporated, enter state and date of incorporation. ❏ Street and Mobile Food Services Vendor State _________________ Mo. _____ Day _____ Yr _____otherwise go to Line 5. 5. Business Name (Individual, Partnership, Corporation) 6. Trade Name (if different from Line 5) 7. Business Address (PO Box is not acceptable unless located in a Rural Area) 8. Mailing Address 9. Local Business Phone No. 10. Main Office Phone No. ( ) ( ) 12. If previously registered with the DC, please provide: 10(a). Fax No. ( ) 11. Date present business began or is expected to begin in DC Mo. ________ Day ________ Year ________ Former Entity Name __________________________________________ Business Tax Registration Number ___________________________________ Former Trade Name ___________________________________________ Name of Former Owner(s) _________________________________________ 13. NAME, TITLE, HOME ADDRESS, SOCIAL SECURITY NUMBER OF PROPRIETOR, PARTNERS OR PRINCIPAL OFFICERS Name and Title Home Address Zip Code Social Security Number Name and Title E-mail Address Home Address Zip Code Social Security Number Name and Title E-mail Address Home Address Zip Code Social Security Number E-mail Address PART II — Franchise Tax Registration 14. Indicate your profession, principal business activity or service (for example, retail grocery, wholesale auto parts, barber shop, doctor, contractor, etc.) 15. Do you or will you have an office, warehouse, or other place of business in DC, or a representative with a DC location? ❏ Yes ❏ No 16. Do you or will you have merchandise stored in a public or private warehouse in DC? ❏ Yes ❏ No 17. Do you or will you perform in DC personal services (medical, accounting, consulting); or other services such as electrical, heating, construction, etc., or installations or repairs of any type? ❏ Yes ❏ No 18. Do you or will you generate any business related income from DC sources? ❏ Yes ❏ No 19. Do you or will you have rental property in DC? ❏ Yes ❏ No 21. Date on which your taxable year ends: 20. Date converted or expected to be converted to rental property ____/____/____ Month ________ Day ________ Year ________ (❏ Calendar or ❏ Fiscal) 22. Describe fully ALL your current or expected business activities and/or major type of services performed within DC. (Attach separate sheet if necessary.) (Rev. 03/14) — INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED AND WILL BE RETURNED — PART III — Employer’s DC Withholding Tax Registration 23. Estimated total number of employees __________ 24. Number of DC resident employees subject to DC Withholding Tax: _______________ 25a. Date when you began to employ DC resident(s) ____-____-____ mo. day yr. 26. Estimate of amount of DC tax to be withheld monthly from DC resident employees: 25b. Date when you began or when you expect to begin to withhold DC tax from resident employees ____-____-____ 27. Will you have employee(s) working in DC? 28. Withholding from retirement accounts or plans Yes No PART IV — Sales and Use Tax Registration 29. Check applicable box(es) below Reporting Sales Tax on retail sales or rentals. Reporting Use Tax on items purchased tax free inside/outside DC Purchasing in DC items for resale outside DC (Attach photocopy of state/county sales tax registration.) Purchasing in DC cigarettes for resale outside DC (Attach photocopy of state/county cigarette/tobacco license.) Making no taxable sales and tax is paid to vendors on all taxable purchases. Making exempt sales where a Certificate of Resale is issued. Street and Mobile Food Services Vendor. 30. Date when sales/use began in DC (mo./day/yr.) ______/______/______ or date expected to begin. 31. If you have more than one place of business where you collect taxes on sales in DC, do you wish to file a Combined Sales Tax Return for all locations? Please attach a statement listing the additional places of business. Yes No PART V, Section 1 — Personal Property Tax Registration Describe the type of Personal Property at each location (ex. furniture, fixtures, machinery equipment and supplies), used for business purposes. PART V, Section 2 — Ballpark Fee Registration Are annual gross receipts greater than $5 million? Yes No Begin date (MMDDYYYY) __ /___/____ End date (MMDDYYYY) ___/___/____ PART V, Section 3 — Nursing Facility/Registration Yes No Begin date (MMDDYYYY) ____/____/________ End date (MMDDYYYY) ____/____/________ PART V, Section 4 — Tobacco Products Excise Tax Registration Yes No Begin date (MMDDYYYY) ____/____/________ End date (MMDDYYYY) ____/____/________ PART V, Section 5 — Intermediate Care Facility for Persons with Intellectual or Developmental Disabilities (ICF-IDD) Tax Registration Yes No Begin date (MMDDYYYY) ____/____/________ End date (MMDDYYYY) ____/____/________ PART V, Section 6 — Hospital Revenue Assessment Yes No Begin date (MMDDYYYY) ____/____/________ End date (MMDDYYYY) ____/____/________ PART V, Section 7 — Hospital Provider Fee Yes No Begin date (MMDDYYYY) ____/____/________ End date (MMDDYYYY) ____/____/________ PART V, Section 8 — Miscellaneous Tax Registration Check applicable block(s) below and the appropriate payment booklets/returns will be sent to you or available on the website. Alcoholic Beverage Wholesaler Gross Receipts Tax on Heating Oil Cable Television, Satellite Relay or Distribution of Video or Radio Transmission only Interstate Bus Cigarette Wholesaler Motor Vehicle Fuel Tax Commercial Mobile Service Tax Gross Receipts Tax on Natural or Artificial Gas by Gross Receipts Public Utility Non-Public Utility Person Gross Receipts Tax on Toll Telecommunication Service Medical Marijuana If you have questions please contact the Customer Service Administration at (202) 727-4TAX (4829). CERTIFICATION I declare under penalties as provided by law that this application (including any accompanying schedules and statements) has been examined by me and, to the best of my knowledge, it is correct. Signature Title Date APPLICATIONS WHEN COMPLETED MUST BE SIGNED BY EITHER THE OWNER, PARTNER OR PRINCIPAL OFFICER OF THE CORPORATION. (Agents or Representatives signing must attach a Power of Attorney.) OFFICIAL USE ONLY Type Tax Date Lia. began Cycle Method H J W S P MISC Reviewer/Date Date Data Entered/Initials Remarks COMPLETE PART VI TO DETERMINE UNEMPLOYMENT INSURANCE LIABILITY Although some information has already been requested in Part 1, this form must be completed in its entirety by all employers who have employees working in the District of Columbia. PART VI will be processed separately from Parts I through V. If you have any questions or need additional information regarding PART VI, please call the DC Department of Employment Services Office of Unemployment Compensation-Tax Division at 202-698-7550 for assistance or email doesregistration@dc.gov Please note that entities completing this form as a requirement for submitting contract proposals with the Government of the District of Columbia MUST complete this form even if they do not have employees who work in the District of Columbia. PART VI — Unemployment Compensation Tax Registration 1. Federal Employer Identification Number 2. Previously assigned unemployment insurance number (if applicable) – 3. Type of ownership (check one) Sole Proprietor Partnership Joint Venture Corporation Household/domestic Limited Liability Company Limited Liability Partnership Other (specify) ___________________________ If incorporated, enter: State __________________ Date ___________________ MM / DD / YYYY – Reason for applying: New Business Additional location Merger (attach merger Purchased existing agreement) business Household/domestic Other (specify) Change of Entity ________________________ Reorganization Name Change (if a corporation attach corporation amendment) 4. Describe in detail your business activity and/or major source of sales that generate sales and use tax; specify the product manufactured and/or sold, or the type of service performed. (Omission of this information may delay the determination of your status.) 5. Legal entity name 6. Trade name (if different from line 5) 7. Street address of DC business, worksite or employee’s home address if working from home. Application will NOT be processed without a DC address. (PO Box is not acceptable) 8a. Mailing address for Tax Correspondence 8b. Mailing address for Benefits Correspondence — COMPLETE REVERSE SIDE — 9. Electronic Means of Communication (REQUIRED) (Leave blank if not applicable) 10. Owner, officer, or agent responsible for reporting and remitting unemployment taxes: Local Voice Number ______________________________ Local Fax Number ______________________________ Main Office Voice Number ______________________________ Main Office Fax Number ______________________________ Tax E-mail Address ______________________________ Website Address ______________________________ Name __________________________________________________ Title ___________________________________________________ Voice No. ______________________________________________ Fax No. ________________________________________________ 11. List proprietor, partners, or principal officers ALL FIELDS MUST BE COMPLETED: Name and Title (REQUIRED) Address (REQUIRED) 12a. Date wages were first paid to employees performing services in DC (write N/A if there were no services performed in DC.) Social Security Number (REQUIRED) This space for official use only. Month: Day: Year: 12b. For household employers only. Do you have an individual in your private DC residence performing personal, rather than business, services to whom you Yes No pay $500 or more in one calendar quarter? If yes: indicate the earliest quarter and calendar year when you paid $500 or more : Quarter: _______ Year: _______ Check your preference for filing Contribution and Wage Reports: Quarterly _____ Annually ______ Account Number ______________________________ Date _________________________________________ Signature _____________________________________ 13. Number of workers employed in DC (including officers). 14. List all places of business in DC BUSINESS NAME LOCATION ADDRESS ZIP CODE 15. If the reason for registering is due to the purchase of an existing business, merger, reorganization, or change of legal entity, or the acquisition, assumption or transfer of the workplace of another entity or entities, provide the following information including the percentage of assets and/or workforce acquired (if needed, attach an additional explanation of transactions). Nature of transfer (check appropriate box): Purchase Merger or consolidation Foreclosure Receivership Lease Corporate Reorganization Bankruptcy Assignment Partnership reorganization (admission or withdrawal of one or more partners). Other (specify in detail): ____________________________________________________________________________________________ Percent of assets acquired: Predecessor ’s Name (Legal Entity Name) % Date of aquisition transfer: Month: Day: Year: Predecessor ’s Account Number Address Trade name (D/B/A) under which transferred business or business that formerly employed your acquired workforce was operated. 16. COMPLETE THIS PART ONLY IF THIS IS A NON-PROFIT ORGANIZATION 16a. Is the organization covered by the Federal Unemployment Tax Act? Yes No If NO, is it exempt under §3306(c)(8) of the Federal Unemployment Tax Act? Yes No 16b.Is the organization exempt from Federal income taxes under §501(c)(3) of the IRS code for religious, educational, or charitable purposes? Yes No (If yes, please attach a copy of the §501(c)(3) exemption letter.) 16c.Choose an option to finance unemployment insurance coverage (see instructions) Contributions Reimbursement of trust fund CERTIFICATION. I declare under penalties as provided by law that Part VI (including any accompanying schedules and statements) has been examined by me and, to the best of my knowledge, it is correct. Print Name Sig nature Email Address Title Date Telephone Number THE COMPLETED PART VI MUST BE SIGNED BY THE OWNER, PARTNER OR PRINCIPAL OFFICER OF THE BUSINESS, OR BY AN AGENT (Power of Attorney must be attached if signed by an agent.) Return completed forms to: Department of Employment Services Office of Unemployment Compensation - Tax Division 4058 Minnesota Ave. NE 4th FL Washington, DC 20019 or email to: doesregistration@dc.gov Please note that wage information and other confidential unemployment compensation information may be requested and used for other government purposes, including determination or verification of an individual eligibility for other government programs, This notice is required by 20 CFR §603.11(b). IMPORTANT NOTICE PLEASE NOTE THAT FAILURE TO COMPLETE ALL ITEMS MARKED “REQUIRED” OR OTHERWISE INDICATED AS REQUIRED WILL EITHER DELAY THE PROCESSING OF THE APPLICATION OR CAUSE THE INCOMPLETE APPLICATION TO BE RETURNED FOR ADDITIONAL INFORMATION.
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