FR500 FR 500 042214
User Manual: FR500
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Page Count: 16

GOVERNMENT OF THE DISTRICT OF COLUMBIA
OFFICE OF THE CHIEF FINANCIAL OFFICER
OFFICE OF TAX AND REVENUE
•  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).
FR-500
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)
COMBINED REGISTRATION APPLICATION FOR BUSINESS DC TAXES/FEES/ASSESSMENTS

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  Oil & Gas Extraction
212110  Coal Mining
212200  Metal Ore Mining
212310  Stone Mining & Quarrying
212320   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
Code
233200   Residential Building 
Construction
233300   Nonresidential Building 
Construction
Heavy Construction
234100   Highway, Street, Bridge, & 
Tunnel Construction
234900  Other Heavy Construction
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
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)
Beverage and Tobacco Product
Manufacturing
312110  Soft Drink & Ice Mfg
312120  Breweries
312130  Wineries
312140  Distilleries
312200  Tobacco Manufacturing
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
Leather and Allied Product 
Manufacturing
316110   Leather & Hide Tanning & 
Finishing
316210   Footwear Mfg (including rubber 
& plastics)
316990   Other Leather & Allied Product 
Mfg
Code
Wood Product Manufacturing
321110   Sawmills & Wood Preservation
321210   Veneer, Plywood, & 
Engineered Wood Product Mfg
321900  Other Wood Product Mfg
Paper Manufacturing
322100  Pulp, Paper & Paperboard Mills
322200  Converted Paper Product Mfg
Printing and Related Support 
Activities
323100   Printing & Related Support 
Activities
Petroleum and Coal Products 
Manufacturing
324100   Petroleum Refineries
(including integrated)
324120   Asphalt Paving, Roofing, &
Saturated Materials Mfg
324190   Other Petroleum & Coal 
Products Mfg
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
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
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
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
Machinery Manufacturing
333100    Agriculture, Construction, & 
Mining Machinery Mfg
333200   Industrial Machinery Mfg
333310   Commercial & Service Industry 
Machinery Mfg
333410   Ventilation, Heating, Air-
Conditioning, & Commercial 
Refrigeration Equipment Mfg
333510   Metalworking Machinery Mfg
333610   Engine, Turbine & Power 
Transmission Equipment Mfg
Code
333900   Other General Purpose 
Machinery Mfg
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
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.
If a company purchases raw materials and supplies them to a subcontrac-
tor to produce the finished product, but retains title to the product, the com-
pany is considered a manufacturer and must use one of the manufacturing 
codes (311110-339900).
1

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
Retail Trade
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
Code
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
General Merchandise Stores
452110  Department Stores
452900   Other General Merchandise 
Stores
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)
Nonstore Retailers
454110   Electronic Shopping & Mail-
Order 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 door-
to-door retailing, frozen food 
plan providers, party plan 
merchandisers, & coffee-break 
service providers)
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, Long-
distance
484200  Specialized Freight Trucking
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
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
Code
488990   Other Support Activities for 
Transportation
Couriers and Messengers
492110  Couriers
492210   Local Messengers & Local 
Delivery
Warehousing And Storage
493100   Warehousing & Storage (except 
lessors of miniwarehouses & 
self-storage units)
Information 
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)
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
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
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)
Code
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
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
2

Code
Architectural Engineering, and 
Related Services
541350   Building Inspection Services
541360   Geophysical Surveying & 
Mapping Services
541370    Surveying & Mapping (except 
Geophysical) Services
541380  Testing Laboratories
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 reposses-
sion services, court reporting, & 
stenotype services)
Code
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 (includ-
ing packaging & labeling servic-
es, & convention & trade show 
organizers)
Waste Management and Remediation 
Services
562000   Waste Management & 
Remediation Services
Educational Services
611000   Educational Services
(including schools, colleges, & 
universities)
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 of Other Health Practitioners
621310  Offices of Chiropractors
621320  Offices of Optometrists
621330   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
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
Medical and Diagnostic Laboratories
621510   Medical & Diagnostic 
Laboratories
Home Health Care Services
621610 Home Health Care Services
Code
Other Ambulatory Health Care 
Services
621900   Other Ambulatory Health Care 
Services (including ambulance 
services & blood & organ 
banks)
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
Arts, Entertainment, and 
Recreation
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
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)
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
Code
Food Services and Drinking Places
722110  Full-Service Restaurants
722210  Limited-Service Eating Places
722300   Special Food Services (includ-
ing food service contractors & 
caterers)
722330  Mobile Food Vendors Including  
             Trucks and Hot Dog Carts
722410   Drinking Places (Alcoholic 
Beverages)
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 reduc-
ing centers)
812210   Funeral Homes & Funeral 
Services
812220  Cemeteries & Crematories
812310   Coin-Operated Laundries & 
Drycleaners
812320   Drycleaning & Laundry 
Services (except Coin-
Operated)
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 follow-
ing 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 pro vided.
The identification number(s) entered on the Form FR-500 will 
be used only for tax administration purposes.
PART II
DC TAX REQUIREMENTS
Corporation Franchise Tax
Unincorporated Business Franchise 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 cor-
poration’s taxable year. If the amount of DC Gross Receipts 
owed is less than the $250 minimum required payment, $250 
must be paid.
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
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-profi t Organizations — Organizations subject to tax on unrelated 
business income, as defi ned in IRC §512, must fi le a Form D-20, Cor-
poration Franchise Tax return. The due date for this fi ling is the 15th 
day of the fi fth 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 fi le 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, fi le 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, fi le 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 with-
holding tax liability is greater than or equal to $1201 per period, fi le 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 fi le and pay electronically. 
Visit www.taxpayerservicecenter.com
PART IV
Sales and Use Tax
Sales Tax — Every sales vendor, mobile food services vendor and 
Business Benefi cial License Holder (BBLH) who has made any sale at 
retail taxable under the provisions of District of Columbia (DC) Offi cial 
Code §47-2001 et seq., shall fi le 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 fi led; 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, fi le 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, fi le 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, fi le a monthly return, 
FR-800M. The FR-800M is due on or before the 20th day of the month 
following the month being reported.

The promoter of a Special Event must provide a list of the par-
ticipants (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 informa-
tion.
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.
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 fi le 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 fi le 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.
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.
Employer Use Tax Return Act of 2012
Any employer required to fi le a DC withholding tax return, which is 
not otherwise required to collect and remit sales tax, shall fi le an 
annual use tax return on or before October 20th of each year, remit-
ting with such return the use taxes which are due.
Note:  If your sales tax liability is $5,000 or greater, you shall fi le 
and pay electronically.  Visit www.taxpayerservicecenter.com
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 agen-
cies, 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.
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
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.
Note: If your personal property tax liability is $5,000 or greater, you  
shall file and pay electronically. 
Visit www.taxpayerservicecenter.com
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 calen-
dar 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.
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.
PART V, Section 4
Tobacco Products Excise Tax
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)
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 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 pro-
vider 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. 

7
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

8
Unemployment Compensation Tax — Employers who hire one or 
more persons to perform services in DC must register for 
Unemployment Compensation Taxes. Domestic/ house  hold employ-
ers 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.
ITEM 16 OF PART VI SHOULD ONLY BE COMPLETED BY NON-
PROFIT ORGANIZATIONS. If the organization is exempt from fed-
eral unemployment taxes, check the appropriate box and include a 
copy of the Internal Revenue Service exemption letter.
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.
All items marked "REQUIRED" must be completed. Failure to com-
plete the required items will delay the processing of the registration.
PERCENTAGE OF ASSETS ACQUIRED. Enter the appropriate infor-
mation in Item 15 of Part VI of the form. List any prior DC ID num-
ber issued to you or to the business.
If you are a new employer acquiring your business from a predeces-
sor, 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 deter-
mine your experience rate. If changing the trade name, include the 
former trade name.
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 fac-
simile number is (202) 698-5706.
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
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.

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
■■
■■–
■■■■■■
■■■■■■
■
■
2.  NAICS Business Code 
■■■■■■
■■■■■■
1(b).  Social Security Number  
■■■
■■■–
■■
■■–
■■■■
■■■■
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
 ❏ Street and Mobile Food Services Vendor 
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.  10(a).  Fax No.  11.  Date present business began or is
               expected to begin in DC
(          )  (          )  (          )  Mo. ________ Day ________ Year ________ 
12. If previously registered with the DC, please provide:
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  Home Address  Zip Code  Social Security Number
Name and Title  Home Address  Zip Code  Social Security Number
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     20.  Date converted or expected to be converted to rental property  ____/____/____
21.  Date on which your taxable year ends:        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.)
— INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED AND WILL BE RETURNED —
Mandatory: If incorporated, enter state and date of incorporation.
State _________________ Mo. _____ Day _____ Yr _____otherwise go to Line 5.
E-mail Address
E-mail Address
E-mail Address
(Rev. 03/14 )
FR-500

PART III — Employer’s DC Withholding Tax Registration
PART IV — Sales and Use 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)  ____-____-____ 26.  Estimate of amount of DC tax to be withheld monthly from
mo.  day    yr. 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
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.
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?             Yes     No
Please attach a statement listing the additional places of business.
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
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) ____/____/________
Begin date (MMDDYYYY) __ /___/____    End date (MMDDYYYY) ___/___/____
Street and Mobile Food Services Vendor.
Yes     No

PART V, Section 8 — Miscellaneous Tax Registration
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.
etaDeltiTerutangiS
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
.)
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 
nosreP ytilitU cilbuP-noNytilitU cilbuP stpieceR ssorG
Gross Receipts Tax on Toll Telecommunication Service
If you have questions please contact the Customer Service Administration at (202) 727-4TAX (4829).
OFFICIAL USE ONLY
Type Date Lia.
Tax began Cycle Method Remarks
H
J
W
S
P
MISC
Reviewer/Date
Date Data Entered/Initials
Medical Marijuana

PART VI — Unemployment Compensation Tax Registration
1. Federal Employer
Identification Number –
3. Type of ownership 
(check one)
Sole Proprietor Household/domestic
Partnership Limited Liability Company
Joint Venture Limited Liability Partnership
Corporation Other (specify)
___________________________
If incorporated, enter:
State __________________ Date ___________________
MM / DD / YYYY
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 8a. Mailing address for Tax Correspondence
Mailing address for Benefits Correspondence
address if working from home. Application will NOT be processed
without a DC address. (PO Box is not acceptable)
2. Previously assigned unemployment
insurance number 
(if applicable) 
–
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)
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
— COMPLETE REVERSE SIDE —
8b.
COMPLETE PART VI TO DETERMINE UNEMPLOYMENT INSURANCE LIABILITY
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.

12a. Date wages were first paid to employees performing services in DC 
(write N/A if there were no services performed in DC.)
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
pay $500 or more in one calendar quarter?   Yes    No
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 ______
13. Number of workers employed in DC (including officers).
14. List all places of business in DC
EDOC PIZSSERDDA NOITACOLEMAN SSENISUB
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:                     %       Date of aquisition transfer:     Month:               Day:                Year: 
rebmuN
tnuoccA
s’rossecederPe (Legal Entity Name)maN
s’rossecederP
Address
Trade name (D/B/A) under which transferred business or business that formerly employed your acquired workforce was operated.
This space for official use only.
Account Number ______________________________
Date _________________________________________
Signature _____________________________________
11.  List proprietor, partners, or principal officers ALL FIELDS MUST BE COMPLETED:
r (REQUIRED)ebmuN ytiruceS laicoSs (REQUIRED)serddAe (REQUIRED)ltiT dna emaN
9. Electronic Means of Communication (REQUIRED)
(Leave blank if not applicable)
Local Voice Number ______________________________
Local Fax Number ______________________________
Main Office Voice Number ______________________________
Main Office Fax Number ______________________________
Tax E-mail Address            ______________________________
Website Address ______________________________
10. Owner, officer, or agent responsible for reporting and remitting  
unemployment taxes:
Name __________________________________________________
Title ___________________________________________________
Voice No. ______________________________________________
Fax No. ________________________________________________

16. COMPLETE THIS PART ONLY IF THIS IS A NON-PROFIT ORGANIZATION
16a.Is the organization covered by the Federal Unemployment Tax Act? 16b.Is the organization exempt from Federal income taxes under
Yes             No
Unemployment Tax Act? Yes     No
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.
rebmuN
enohpeleTetaDeltiTerutangiS
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
4058 Minnesota Ave. NE 4th FL
Office of Unemployment Compensation - Tax Division
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). 
§501(c)(3) of the IRS code for religious, educational, or 
charitable purposes?
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.
Print Name   Email Address
If NO, is it exempt under 
§3306(c)(8) of the Federal