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Common mistakes
Filling out the PA-100 form can be a straightforward process, but many individuals make common mistakes that can lead to delays or complications. Understanding these pitfalls is essential for a successful registration.
One frequent mistake is incomplete information. New registrants often overlook sections that require detailed responses. Every item in sections 1 through 10 must be filled out. Failing to provide complete information can result in processing delays. Double-checking each section before submission is crucial.
Another common error involves illegible handwriting. Many registrants do not type or print clearly, using ink that is difficult to read. This can lead to misunderstandings or misinterpretations of the provided information. Always use black ink and ensure that your writing is legible to avoid these issues.
Some individuals also forget to sign the form. It may seem trivial, but without a signature, the form is not valid. Make sure to sign and date the registration form before mailing it to the PA Department of Revenue. This small step is essential for the processing of your application.
Additionally, many registrants fail to retain a copy of the completed form. Keeping a copy for your records is important in case any issues arise later. If the department needs to verify information, having a copy will make it easier to respond to any inquiries.
Another mistake is not adhering to the date format specified in the instructions. The PA-100 form requires dates to be entered in the mm/DD/yyyy format. Submitting dates in a different format can lead to confusion and errors in processing.
Lastly, individuals often neglect to enclose payment for any required fees. If applicable, ensure that you include payment with your form. This oversight can delay the registration process significantly. Always verify the fee requirements based on the services you are registering for.
By avoiding these common mistakes, you can streamline the registration process and ensure that your PA-100 form is processed efficiently.
Dos and Don'ts
Things to Do When Filling Out the PA-100 Form:
- Complete every item in sections 1 through 10 if you are a new registrant.
- Type or print legibly using black ink to ensure clarity.
- Retain a copy of the completed registration form for your records.
- Enclose payment for any applicable license or registration fees.
- Sign the registration form to validate your submission.
- Notify the Bureau of Business Trust Fund Taxes in writing within 30 days of any changes to your information.
Things Not to Do When Filling Out the PA-100 Form:
- Do not leave any required fields blank; incomplete forms may cause delays.
- Avoid using a PO Box for your street address; provide a physical location instead.
- Do not forget to check the applicable boxes for taxes and services requested.
- Do not submit the form without reviewing it for accuracy.
- Do not rely solely on this form for corporate tax registration; contact the PA Department of State for that purpose.
- Do not attach documents out of order; ensure pages are sequentially arranged before mailing.
Fill out Common Documents
Pa Department of Revenue Power of Attorney - Commonwealth agencies must adhere to refund guidelines outlined in this form.
Pa Department of Revenue Forms - Incorrect entries could require filing an amended return later.
This necessary Dirt Bike Bill of Sale documentation is vital for ensuring that the transfer of ownership is legally recognized and protects both parties involved in the transaction.
302 Medical Code - Participants are encouraged to review their choices regularly for accuracy.
Similar forms
The PA-100 form is similar to the IRS Form SS-4, which is used to apply for an Employer Identification Number (EIN). Both forms serve as registration tools for businesses, enabling them to obtain necessary identification for tax purposes. The PA-100 form registers enterprises for various state taxes and services, while the SS-4 focuses on establishing federal tax identification. Completing either form is crucial for compliance with tax regulations, and both require detailed information about the business structure and ownership.
The Georgia WC 100 form is essential for businesses operating in Georgia as it facilitates the mediation process in workers' compensation cases, allowing for settlements to be reached more efficiently. A thorough understanding of this form and its implications is vital for employees, employers, and insurers alike. For more information on this process and the form itself, you can visit formsgeorgia.com/.
Another document akin to the PA-100 is the Pennsylvania Sales Tax License Application. This application is specifically designed for businesses that intend to sell taxable goods or services in Pennsylvania. Like the PA-100, it requires information about the business's structure and operations. The Sales Tax License Application ensures that businesses can collect and remit sales tax, thus fulfilling their legal obligations. Both documents are vital for ensuring that enterprises operate within the legal framework established by state tax authorities.
The IRS Form 940, which is used to report annual Federal Unemployment Tax Act (FUTA) taxes, shares similarities with the PA-100 form. Both forms are utilized by businesses to comply with unemployment tax regulations, albeit at different governmental levels. While the PA-100 registers enterprises for state-level unemployment compensation, the Form 940 addresses federal unemployment tax responsibilities. Each form requires businesses to provide detailed information about their employees and payroll, ensuring that they meet their tax obligations.
The Pennsylvania Corporate Tax Report (RCT-101) is another document that resembles the PA-100 form. This report is required for corporations operating in Pennsylvania and is used to report corporate income and franchise taxes. Both forms require comprehensive information about the business's financial activities and structure. While the PA-100 focuses on registration for various taxes and services, the RCT-101 is specifically aimed at corporate taxation, highlighting the different tax obligations that businesses must navigate.
Additionally, the Pennsylvania Employer Withholding Tax Registration form is similar to the PA-100 in that it is used to register businesses for withholding taxes on employee wages. Both forms require details about the business structure and ownership. The Employer Withholding Tax Registration ensures that businesses can properly withhold and remit state income taxes from their employees' paychecks, while the PA-100 covers a broader range of tax registrations and services.
Lastly, the Pennsylvania Unemployment Compensation (UC) Application is comparable to the PA-100 form, as it is used by employers to register for unemployment compensation insurance. Both documents require businesses to provide information about their employees and payroll. While the PA-100 serves as a general registration for various taxes and services, the UC Application focuses specifically on the requirements for unemployment compensation, ensuring that businesses comply with state regulations regarding employee benefits.
Guidelines on How to Fill Out Pa100
Completing the PA-100 form is an essential step for businesses operating in Pennsylvania to ensure proper registration for various taxes and services. Once the form is filled out accurately, it needs to be submitted to the Pennsylvania Department of Revenue. Below are the detailed steps to guide you through the process of filling out the PA-100 form.
- Gather all necessary information about your enterprise, including its legal name, trade name, and federal employer identification number (EIN).
- Begin with Section 1, where you will check the applicable box to indicate the reason for registration (e.g., new registration, adding taxes, etc.).
- Proceed to Section 2, and fill in details about your enterprise, such as the date of first operations, enterprise fiscal year end, and contact information.
- In Section 3, check all applicable taxes and services that your enterprise will be registering for, ensuring to complete any corresponding sections as indicated.
- Sign Section 4 with an authorized signature, and include the date and daytime telephone number. If applicable, attach a power of attorney.
- Complete Section 5 by selecting the appropriate business structure (e.g., corporation, partnership, etc.).
- Fill out Section 6 with information about owners, partners, shareholders, and responsible parties, ensuring all required fields are completed.
- If applicable, complete Section 6a for additional owners or partners.
- In Section 7, provide details about the establishment business activity, including the nature of the business conducted.
- Continue to Section 8, where you will enter establishment sales information, including gross sales and receipts.
- In Section 9, provide establishment employment information, including the number of employees and wages paid.
- If applicable, complete Section 10 with bulk sale or transfer information.
- Review all sections for accuracy and completeness, ensuring that every item is filled out legibly using black ink.
- Retain a copy of the completed registration form for your records.
- Mail the completed form to the Pennsylvania Department of Revenue at the provided address: PO Box 280901, Harrisburg, PA 17128-0901.
Form Preview Example
CommonweAlTh of PennsylvAniA DePARTmenT of Revenue
buReAu of business TRusT funD TAxes Po box 280901
hARRisbuRg, PA
Go Paperless . . .
REGISTER ON THE INTERNET
www.pa100.state.pa.us
P E N N S Y LV A N I A
ENTERPRISE
REGISTRATION
F O R M A N D I N S T R U C T I O N S
AUXILIARY AIDS AND SERVICES ARE AVAILABLE UPON REQUEST TO INDIVIDUALS WITH DISABILITIES.
EQUAL OPPORTUNITY EMPLOYER/PROGRAM.
DETACH AND MAIL COMPLETED REGISTRATION FORM TO:
COMMONWEALTH OF PA • DEPARTMENT OF REVENUE • BUREAU OF BUSINESS TRUST FUND TAXES • PO BOX 280901 • HARRISBURG, PA
PE N NSYLVA NIA E NTERPRISE REGISTRATIO N
The Pennsylvania enterprise Registration form
for registration assistance, contact:
(717)
What is an enterprise?
An enterprise is any individual or organization,
lPays wages to employees
What is an establishment?
An establishment is an economic unit, generally at a single physical location where:
lbusiness is conducted inside PA
lbusiness is conducted outside PA with reporting requirements to PA
lPA residents are employed, inside or outside of PA.
loffers products for sale to others
loffers services for sale to others
lCollects donations
lCollects taxes
lis allocated use of tax dollars
lhas a name which is intended for use and, by that name, is to be recognized as an organization engaged in economic activity.
The enterprise and the establishment may have the same physical location.
Multiple establishments exist if the following apply:
lbusiness is conducted at multiple locations.
lDistinct and separate economic activities involving separate employees are performed at a single location. each activity may be treated as a separate establishment as long as separate reports can be prepared for the number of employees, wages and salaries, or sales and receipts.
How to complete the registration form:
l New registrants must complete every item in sections 1 through 10 and additional sections as indicated.
How to avoid delays in processing:
lReview the registration form and accompanying sections to be sure that every item is complete. The preparer will be contacted
lRegistered enterprises must complete every item in sections 1 through 6 and additional sections as indicated.
lsection 5 has indicators to direct the registrant to additional sections.
lTo determine the registration requirements for a specific tax ser- vice and/or license, see pages 2 and 3.
lType or print legibly using black ink.
lenter all dates in mm/DD/yyyy format (e.g. 01/01/2005).
lRetain a copy of the completed registration form for your records.
to supply information if required sections are not completed.
lenclose payment for license or registration fees, payable to
PA Department of Revenue.
lif a quarterly uC Report/payment is submitted, attach a separate check payable to PA Unemployment Compensation Fund.
lsign the registration form.
lRemove completed pages from the booklet, arrange in sequen- tial order, and mail to the PA Department of Revenue.
It is your responsibility to notify the Bureau of Business Trust Fund Taxes in writing within 30 days of any change to the information provided on the registration form.
Completing this form will NOT fulfill the requirement to register for corporate taxes. Registering corporations must contact the PA Department of State to secure corporate name clearance and register for corporation tax purposes. Contact the PA Depart- ment of State at (717)
TABLE OF
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Form |
Inst. |
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Section |
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Page |
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mailing Address |
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front Cover |
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Taxes and services (definitions & requirements) . |
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1 |
Reason for this Registration |
. . . . .4 |
. . . . . |
. .18 |
2 |
enterprise information |
. . . . .4 |
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3 |
Taxes & services |
. . . . .4 |
. . . . . |
. .19 |
4 |
Authorized signature |
. . . . .4 |
. . . . . |
. .19 |
5 |
business structure |
. . . . .5 |
. . . . . |
. .19 |
6 |
owners, Partners, shareholders, officers, |
. . . . .5 |
. . . . . |
. .19 |
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Responsible Party information |
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6a |
Additional owners, Partners, shareholders, |
. . . .11 . . . . |
. .19 |
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officers, Responsible Party information |
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7establishment business Activity
8 establishment sales information . . . . . . . . . . . . .6 . . . . . . .22 9 establishment employment information . . . . . . . .6 . . . . . . .22 10 bulk sale/Transfer information . . . . . . . . . . . . . .6 . . . . . . .22 11 Corporation information . . . . . . . . . . . . . . . . . . . .7 . . . . . . .22 12 Reporting & Payment methods . . . . . . . . . . . . . .7 . . . . . . .22
CO NTE NTS
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Form |
Inst. |
Section |
Page |
Page |
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13 |
government structure |
. .7 |
. .23 |
14 |
Predecessor/successor information |
. .8 |
. .23 |
15 |
Application for PA uC experience Record & . . |
. .9 |
. .23 |
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Reserve Account balance of Predecessor |
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16 |
unemployment Compensation Partial |
. .9 |
. .24 |
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Transfer information |
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17 |
multiple establishment information |
. .24 |
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18sales use and hotel occupancy Tax
vehicle Rental Tax, Transient vendor
Certificate, Promoter license, or wholesaler Certificate
19 |
Cigarette Dealer’s license |
13 |
. . . . . .25 |
20 |
small games of Chance license/Certificate . . . . |
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21 |
motor Carrier Registration & Decal/motor |
16 |
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fuels license & Permit |
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22 |
sales Tax exempt status for Charitable and . . . . |
17 |
. . . . . .26 |
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Religious organizations |
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Contact information |
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1
THE FOLLOWING CHART WILL HELP DETERMINE THE SECTIONS OF THIS BOOKLET THAT
SHOULD BE COMPLETED FOR VARIOUS TAX TYPES.
COMPLETE THE SECTIONS THAT APPLY TO YOUR ENTERPRISE.
lnew registrants should complete sections 1 through 10 plus the sections indicated.
lPrevious registrants should complete sections 1 through 6 plus the additional sections indicated.
TAXES AND SERVICES |
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REQUIREMENTS |
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SECTIONS TO |
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COMPLETE |
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CigAReTTe DeAleR’s |
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seCTion 19 |
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CIGARETTE TAX is An exCise TAx imPoseD on The sAle oR Possession of |
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liCense |
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CigAReTTes. A DeAleR is Any CigAReTTe sTAmPing AgenT, wholesAleR, |
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oR ReTAileR. |
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sAles TAx liCense |
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seCTion 18 |
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(ReTAileR) |
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CORPORATE NET INCOMEAND CAPITAL STOCK FRANCHISE TAXESARe imPoseD |
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RegisTRATion wiTh |
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on DomesTiC AnD foReign CoRPoRATions, CeRTAin business TRusTs, AnD |
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seCTion 11 |
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limiTeD liAbiliTy ComPAnies whiCh ARe RegisTeReD AnD/oR TRAnsACTing |
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foRms musT be obTAineD |
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business wiThin The CommonweAlTh of PennsylvAniA. subJeCTiviTy To |
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fRom PA DePARTmenT of |
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sTATe |
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sPeCifiC CoRPoRATion TAxes is DeTeRmineD by The TyPe of CoRPoRATe |
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oRgAniZATion AnD The ACTiviTy ConDuCTeD. |
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l FINANCIAL INSTITUTIONS TAXES: The bAnK AnD TRusT ComPAny shARes |
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TAx is imPoseD on eveRy bAnK AnD TRusT ComPAny hAving CAPiTAl |
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sToCK AnD ConDuCTing business in PennsylvAniA. DomesTiC TiTle |
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RegisTRATion wiTh feDeR- |
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insuRAnCe ComPAnies ARe subJeCT To The TiTle insuRAnCe ComPAny |
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Al oR sTATe AuThoRiTy |
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shARes TAx. The muTuAl ThRifT insTiTuTions TAx is imPoseD on sAv- |
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ThAT gRAnTeD ChARTeR |
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ings insTiTuTions, sAvings bAnKs, sAvings AnD loAn AssoCiATions, |
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AnD builDing AnD loAn AssoCiATions ConDuCTing business in Penn- |
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sylvAniA. CReDiT unions ARe noT subJeCT To TAx. |
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l GROSS PREMIUMS TAX is levieD on DomesTiC AnD foReign insuRAnCe |
l |
RegisTRATion wiTh |
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ComPAnies. The yeARly gRoss PRemiums ReCeiveD foRm The TAx |
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PA DePARTmenT of |
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bAse. gRoss PRemiums ARe PRemiums, PRemium DePosiTs, oR |
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insuRAnCe |
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AssessmenTs, foR business TRAnsACTeD in PennsylvAniA. |
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l GROSS RECEIPTS TAX is levieD on PiPeline, ConDuiT, wATeR nAvigATion |
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AnD TRAnsPoRTATion ComPAnies; TelePhone, TelegRAPh AnD mobile |
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RegisTRATion wiTh PA |
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TeleCommuniCATions ComPAnies; eleCTRiC lighT, wATeR PoweR AnD |
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PubliC uTiliTy |
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hyDRoeleCTRiC ComPAnies; AnD fReighT AnD oil TRAnsPoRTATion |
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ComPAnies. |
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The TAx is bAseD on gRoss ReCeiPTs fRom PAssengeRs, bAggAge |
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AnD fReighT TRAnsPoRTeD wiThin PennsylvAniA; TelegRAPh AnD |
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TelePhone messAges TRAnsmiTTeD wiThin PennsylvAniA; AnD sAles |
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of eleCTRiCiTy in PennsylvAniA. |
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l PUBLIC UTILITY REALTY TAX is levieD AgAinsT CeRTAin enTiTies fuR- |
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nishing uTiliTy seRviCes. PennsylvAniA imPoses This TAx on PubliC |
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RegisTRATion wiTh PA |
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uTiliTy ReAlTy in lieu of loCAl ReAl esTATe TAxes AnD DisTRibuTes |
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PubliC uTiliTy Commission |
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The loCAl ReAlTy TAx eQuivAlenT To loCAl TAxing AuThoRiTies. |
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l OTHER CORPORATION TAXES: This gRouP is ComPoseD PRimARily of |
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RegisTRATion wiTh PA |
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The CoRPoRATe loAns TAx, The CooPeRATive AgRiCulTuRAl AssoCiA- |
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DePARTmenT of sTATe |
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Tion AnD eleCTRiC CooPeRATive CoRPoRATion TAxes. |
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EMPLOYER WITHHOLDING is The wiThholDing of PennsylvAniA PeRsonAl |
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inCome TAx by emPloyeRs fRom ComPensATion PAiD To PennsylvAniA |
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seCTion 9 |
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ResiDenT emPloyees foR woRK PeRfoRmeD insiDe oR ouTsiDe of Penn- |
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sylvAniA AnD nonResiDenT emPloyees foR woRK PeRfoRmeD insiDe |
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PennsylvAniA. (see unemPloymenT ComPensATion DefiniTion) |
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LIQUID FUELS AND FUELS TAX is An exCise TAx imPoseD on All liQuiD fuels |
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AnD fuels useD oR solD AnD DeliveReD by DisTRibuToRs wiThin Penn- |
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sylvAniA, exCePT Those DeliveReD To exemPT PuRChAseRs. liQuiD fuels |
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liQuiD fuels AnD fuels |
l |
seCTion 21 |
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inCluDe gAsoline, gAsohol, JeT fuel, AnD AviATion gAsoline. fuels |
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TAx PeRmiT |
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inCluDe CleAR Diesel fuel AnD KeRosene. ADDiTionAlly, The liQuiD |
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fuels AnD fuels TAx ACT TAxes AlTeRnATive fuels (i.e. highwAy fuels |
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oTheR ThAn liQuiD fuels oR fuels) AT A ReTAil/use TAx level. |
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MOTOR CARRIERS ROAD TAX is imPoseD on moToR CARRieRs engAgeD in |
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oPeRATions on PennsylvAniA highwAys. A moToR CARRieR is Any PeRson |
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ifTA liCense AnD |
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oR enTeRPRise oPeRATing A QuAlifieD moToR vehiCle useD, DesigneD, |
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ifTA DeCAls |
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oR mAinTAineD foR The TRAnsPoRTATion of PeRsons oR PRoPeRTy |
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wheRe (A) The PoweR uniT hAs Two Axles AnD A gRoss oR RegisTeReD |
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PA |
l |
seCTion 21 |
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gRoss weighT gReATeR ThAn 26,000 PounDs, (b) The PoweR uniT hAs |
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RegisTRATion AnD PA non- |
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ThRee Axles oR moRe RegARDless of weighT, oR (C) vehiCles ARe useD |
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ifTA DeCAls |
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in CombinATion AnD The DeClAReD CombinATion weighT exCeeDs 26,000 |
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PounDs oR The gRoss weighT of The vehiCles exCeeDs 26,000 PounDs. |
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2
PROMOTER is Any enTeRPRise engAgeD in RenTing, leAsing, oR gRAnTing PeR- |
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mission To Any PeRson To use sPACe AT A show foR The DisPlAy oR foR The |
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PRomoTeR liCense |
l |
seCTion 18 |
sAle of TAngible PeRsonAl PRoPeRTy oR seRviCes. |
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PUBLIC TRANSPORTATION ASSISTANCE FUND TAX is A TAx oR fee imPoseD on eACh |
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sAles use AnD hoTel |
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sAle in PennsylvAniA of new TiRes foR highwAy use, on The leAse of moToR |
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oCCuPAnCy TAx liCense |
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vehiCles, AnD on The RenTAl of moToR vehiCles. The TAx is Also levieD on The |
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seCTion 18 |
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PubliC TRAnsPoRTATion |
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sTATe TAxAble vAlue of uTiliTy ReAlTy of enTeRPRises subJeCT To The PubliC |
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uTiliTy ReAlTy TAx AnD on PeTRoleum Revenue of oil ComPAnies. |
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AssisTAnCe TAx liCense |
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REPORTING AND PAYMENT METHODS offeR The enTeRPRise The AbiliTy To file |
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CeRTAin TAx ReTuRns AnD mAKe eleCTRoniC PAymenTs ThRough The eleCTRon- |
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iC TAx infoRmATion AnD DATA exChAnge sysTem |
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sysTem. eleCTRoniC PAymenT mAy Also be mADe ThRough eleCTRoniC funDs |
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AuThoRiZATion |
l |
seCTion 12 |
TRAnsfeR (efT) oR CReDiT CARD. unemPloymenT ComPensATion (uC) wAges mAy |
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AgReemenT |
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be RePoRTeD viA A mAgneTiC meDium. in CeRTAin insTAnCes, An enTeRPRise mAy |
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eleCT To finAnCe uC CosTs unDeR A ReimbuRsemenT meThoD RATheR ThAn The |
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ConTRibuToRy meThoD. |
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SALES TAX isAn exCise TAx imPoseD on The ReTAil sAle oR leAse of TAxAble, TAn- |
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sAles use AnD hoTel |
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seCTion 18 |
gible PeRsonAl PRoPeRTy, AnD on sPeCifieD seRviCes. |
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oCCuPAnCy TAx liCense |
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l HOTEL OCCUPANCY TAX is An exCise TAx imPoseD on eveRy hoTel oR moTel |
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sAles use AnD hoTel |
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seCTion 18 |
Room oCCuPAnCy less ThAn 30 ConseCuTive DAys. |
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oCCuPAnCy TAx liCense |
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l LOCALSALES TAX mAy be imPoseD in PhilADelPhiAoRAllegheny CounTies, in |
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sAles use AnD hoTel |
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ADDiTion To The sTATe sAles AnD use TAx, on The ReTAil sAle oR use of TAn- |
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gible PeRsonAl PRoPeRTy AnD seRviCes AnD on hoTel/moTel oCCuPAnCies. |
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oCCuPAnCy TAx liCense |
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seCTion 18 |
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SALES TAX EXEMPT STATUS FOR CHARITABLEAND RELIGIOUS ORGANIZATIONS is The |
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QuAlifiCATion of An insTiTuTion of PuRely PubliC ChARiTy To be exemPT fRom |
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CeRTifiCATe of exemPT |
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seCTion 22 |
sAles AnD use TAx on The PuRChAse of TAngible PeRsonAl PRoPeRTy oR seR- |
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sAles TAx sTATus |
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viCes foR use in ChARiTAble ACTiviTy. |
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l smAll gAmes of ChAnCe |
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SMALL GAMES OF CHANCE is The RegulATion of limiTeD gAmes of ChAnCe ThAT |
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DisTRibuToR liCense |
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QuAlifieD ChARiTAble AnD |
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AnD/oR |
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seCTion 20 |
sylvAniA. |
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mAnufACTuReR |
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RegisTRATion CeRTifiCATe |
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TRANSIENT VENDOR is Any enTeRPRise whose business sTRuCTuRe is sole PRo- |
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PRieToR oR PARTneRshiP, noT hAving A PeRmAnenT PhysiCAl business loCATion |
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TRAnsienT venDoR |
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seCTion 18 |
in PennsylvAniA, whiCh sells TAxAble, TAngible PeRsonAl PRoPeRTy oR PeR- |
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CeRTifiCATe |
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foRms TAxAble seRviCes in PennsylvAniA. |
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UNEMPLOYMENT COMPENSATION (UC) PRoviDes A funD fRom whiCh ComPensATion |
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is PAiD To woRKeRs who hAve beCome unemPloyeD ThRough no fAulT of TheiR |
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own. ConTRibuTionsARe ReQuiReD To be mADe byAll emPloyeRs who PAy wAges |
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seCTions 7, 9, |
To inDiviDuAls woRKing in PA AnD whose seRviCes ARe CoveReD unDeR The uC |
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APPliCATion foR |
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if APPliCAble |
lAw. This TAx mAy inCluDe emPloyee ConTRibuTions wiThhelD by emPloyeRs |
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10 AnD 14 |
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fRom eACh emPloyee’s gRoss wAges. (see emPloyeR wiThholDing DefiniTion) |
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exPeRienCe ReCoRD AnD |
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ReseRve ACCounT |
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seCTions 14, |
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l APPLICATION FOR PA UC EXPERIENCE RECORD AND RESERVE ACCOUNT BAL- |
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bAlAnCe of PReDeCessoR |
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15. if APPliC- |
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ANCE enAbles The RegisTeRing enTeRPRise To benefiT fRom A PReDeCes- |
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Able, 16 |
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soR’s RePoRTing hisToRy. RefeR To The insTRuCTions To DeTeRmine if This |
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is ADvAnTAgeous. |
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USE TAX is An exCise TAx imPoseD on PRoPeRTy useD in PennsylvAniA on whiCh |
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use TAx ACCounT |
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seCTion 18 |
sAles TAx hAs noT been PAiD. |
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VEHICLE RENTAL TAX is imPoseD on RenTAl ConTRACTs by enTeRPRises hAving |
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sAles use AnD hoTel |
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AvAilAble foR RenTAl: (1) 5 oR moRe moToR vehiCles DesigneD To CARRy 15 oR |
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oCCuPAnCy TAx liCense |
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seCTion 18 |
less PAssengeRs, oR (2) TRuCKs, TRAileRs, oR |
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PTA liCense |
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PoRTATion of PRoPeRTy. A RenTAl ConTRACT is foR A PeRioD of 29 DAys oR less. |
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WHOLESALER CERTIFICATE PeRmiTs An enTeRPRise solely engAgeD in selling |
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TAngible PeRsonAl PRoPeRTy AnD/oR seRviCes foR ResAle. To PuRChAse TAngi- |
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wholesAleR CeRTifiCATe |
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seCTion 18 |
ble PeRsonAl PRoPeRTy oR seRviCes foR ResAle |
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noRmAl CouRse of The enTeRPRise’s business. |
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WORKERS’ COMPENSATION COVERAGE is MANDATORY AnD PRoTeCTs emPloyees |
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fRom wAge loss benefiTs AnD meDiCAl exPenses inCuRReD As A ResulT of Job |
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RelATeD inJuRies oR DiseAses. emPloyeRs ThAT mAinTAin woRKeRs’ ComPensA- |
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Tion CoveRAge ARe immune To lAwsuiTs flowing fRom |
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oTheR ThAn Those ACTions fileD unDeR The woRKeRs’ ComPensATion ACT. |
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eveRy emPloyeR liAble unDeR The PA woRKeRs’ ComPensATion ACT shAll |
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woRKeRs’ ComPensATion |
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seCTion 9 |
insuRe The PAymenT of ComPensATion wiTh The sTATe woRKmen’s insuRAnCe |
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CoveRAge |
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funD, oR wiTh Any PRivATe insuRAnCe ComPAny, oR muTuAl AssoCiATion oR |
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ComPAny, AuThoRiZeD To insuRe suCh liAbiliTy in This CommonweAlTh oR by |
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seCuRing The AuThoRiTy To |
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fRom The CoveRAge ReQuiRemenTs, AnD fAll inTo one oR moRe of The exemPT |
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CATegoRies, woRKeRs’ ComPensATion musT be ConTinuAlly mAinTAineD wiTh |
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no inTeRRuPTion in CoveRAge. |
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3
MAIL COMPLETED APPLICATION TO:
DEPARTMENT OF REVENUE
BUREAU OF BUSINESS TRUST FUND TAXES
PO BOX 280901
HARRISBURG, PA
TYPE OR PRINT LEGIBLY, USE BLACK INK
COMMONWEALTH OF PENNSYLVANIA
PA ENTERPRISE
REGISTRATION FORM
DEPARTMENT USE ONLY
RECEIVED DATE
DePARTmenT of Revenue &
DePARTmenT of lAboR AnD inDusTRy
SECTION 1 – REASON FOR THIS REGISTRATION
RefeR To The insTRuCTions (PAge 18) AnD CheCK The APPliCAble box(es) To inDiCATe The ReAson(s) foR This RegisTRATion.
1. |
o new RegisTRATion |
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2. |
o ADDing TAx(es) & seRviCe(s) |
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3. |
o ReACTivATing TAx(es) & seRviCe(s) |
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4. |
o |
ADDing esTAblishmenT(s) |
5. |
o |
infoRmATion uPDATe |
6. DiD This enTeRPRise:
o yes |
o no |
ACQuiRe All oR PART of AnoTheR business? |
o yes |
o no |
ResulT fRom A ChAnge in legAl sTRuCTuRe (foR exAmPle, fRom inDiviDuAl |
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PRoPRieToR To CoRPoRATion, PARTneRshiP To CoRPoRATion, CoRPoRATion |
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To limiTeD liAbiliTy ComPAny, eTC)? |
o yes |
o no |
unDeRgo A meRgeR, ConsoliDATion, DissoluTion, oR oTheR ResTRuCTuRing? |
SECTION 2 – ENTERPRISE INFORMATION
1. DATe of fiRsT oPeRATions |
2. DATe of fiRsT oPeRATions in PA |
3. enTeRPRise fisCAl yeAR enD
4. |
enTeRPRise legAl nAme |
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5. |
feDeRAl emPloyeR iDenTifiCATion numbeR (ein) |
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6. |
enTeRPRise TRADe nAme (if different than legal name) |
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7. |
enTeRPRise TelePhone numbeR |
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( |
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8. |
enTeRPRise sTReeT ADDRess (do not use PO Box) |
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CiTy/Town |
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CounTy |
sTATe |
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ZiP CoDe + 4 |
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9. |
enTeRPRise mAiling ADDRess (if different than street address) |
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CiTy/Town |
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sTATe |
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ZiP CoDe + 4 |
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10. |
loCATion of enTeRPRise ReCoRDs (street address) |
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CiTy/Town |
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sTATe |
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ZiP CoDe + 4 |
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11. |
esTAblishmenT nAme (doing business as) |
12. numbeR of |
13. PA sChool DisTRiCT |
14. PA muniCiPAliTy |
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esTAblishmenTs * |
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*ENTERPRISES WITH ONE OR MORE ESTABLISHMENTS WITHIN PA, WHOSE PA ADDRESS WAS NOT ENTERED ABOVE, MUST COMPLETE SECTION 17. (SEE GENERAL INSTRUCTIONS AND SECTION 17 FOR MORE INFORMATION.)
SECTION 3 – TAXES AND SERVICES
All RegisTRAnTs musT CheCK The APPliCAble box(es) To inDiCATe The TAx(es) AnD seRviCe(s) ReQuesTeD foR This RegisTRATion AnD ComPleTe The CoRResPonDing seCTions inDiCATeD on PAges 2 AnD 3. if ReACTivATing Any PRevious ACCounT(s), lisT The ACCounT numbeR(s) in The sPACe PRoviDeD.
PREVIOUS |
ACCOUNT NUMBER |
oCigAReTTe DeAleR’s liCense
oCoRPoRATion TAxes
oemPloyeR wiThholDing TAx/1099 misC
ofuels TAx PeRmiT
oliQuiD fuels TAx PeRmiT
omoToR CARRieRs RoAD TAx/ifTA
oPRomoTeR liCense
oPubliC TRAnsPoRTATion AssisTAnCe TAx liCense
osAles TAx exemPT sTATus
SECTION 4 – AUTHORIZED SIGNATURE
o
o o o o o o o
sAles, use, hoTel oCCuPAnCy TAx liCense
smAll gAmes of ChAnCe liC./CeRT.
TRAnsienT venDoR CeRTifiCATe
unemPloymenT ComPensATion
use TAx
vehiCle RenTAl TAx
wholesAleR CeRTifiCATe
woRKeRs’ ComPensATion CoveRAge
i, (we) The unDeRsigneD, DeClARe unDeR The PenAlTies of PeRJuRy ThAT The sTATemenTs ConTAineD heRein ARe TRue, CoRReCT, AnD ComPleTe.
AuThoRiZeD signATuRe (ATTACh PoweR of ATToRney if APPliCAble) |
DAyTime TelePhone numbeR |
TiTle |
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( |
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TyPe oR PRinT nAme |
DATe |
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TyPe oR PRinT PRePAReR’s nAme |
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TiTle |
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DAyTime TelePhone numbeR |
DATe |
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( |
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4
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DePARTmenT use only |
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enTeRPRise nAme |
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SECTION 5 – BUSINESS STRUCTURE
CheCK The APPRoPRiATe box foR QuesTions 1, 2 & 3. in ADDiTion To seCTions 1 ThRough 10, ComPleTe The seCTion(s) inDiCATeD.
1. |
o sole PRoPRieToRshiP (inDiviDuAl) |
o geneRAl PARTneRshiP |
o AssoCiATion |
o limiTeD liAbiliTy ComPAny |
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o CoRPoRATion (sec. 11) |
o limiTeD PARTneRshiP |
o business TRusT |
STATE WHERE CHARTERED |
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o goveRnmenT (sec. 13) |
o limiTeD liAbiliTy PARTneRshiP |
o esTATe |
o ResTRiCTeD PRofessionAl ComPAny |
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o JoinT venTuRe PARTneRshiP |
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STATE WHERE CHARTERED |
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o PRofiT |
o |
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2. |
is The enTeRPRise oRgAniZeD foR PRofiT oR |
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3. |
o yes |
o no |
is The enTeRPRise exemPT fRom TAxATion unDeR inTeRnAl Revenue CoDe (iRC) seCTion 501(c)(3)? if yes, |
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PRoviDe A CoPy of The enTeRPRise's exemPTion AuThoRiZATion leTTeR fRom The inTeRnAl Revenue seRviCe. |
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SECTION 6 – OWNERS, PARTNERS, SHAREHOLDERS, OFFICERS, AND RESPONSIBLE PARTY INFORMATION
PRoviDe The following foR ALL inDiviDuAlAnD/oR enTeRPRise owneRs, PARTneRs, shAReholDeRs, offiCeRs, AnD ResPonsible PARTies. if sToCK is PubliCly TRADeD, PROVIDE THE FOLLOWING FOR ANY SHAREHOLDER WITH AN EQUITY POSITION OF 5% OR MORE. ADDITIONALSPACE ISAVAILABLE IN SECTION 6A, PAGE 11.
1. |
nAme |
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2. soCiAl seCuRiTy numbeR |
3. |
DATe of biRTh * |
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4. |
feDeRAl ein |
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5. |
o owneR |
o offiCeR |
6. TiTle |
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7. effeCTive DATe |
8. |
PeRCenTAge of |
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9. |
effeCTive DATe of |
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o PARTneR |
o shAReholDeR |
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of TiTle |
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owneRshiP |
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owneRshiP |
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o ResPonsible PARTy |
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% |
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10. home ADDRess (street) |
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CiTy/Town |
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CounTy |
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sTATe |
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ZiP CoDe + 4 |
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11. This PeRson is ResPonsible To RemiT/mAinTAin: |
o sAles TAx |
o emPloyeR wiThholDing TAx |
o moToR fuel TAxes |
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owoRKeRs’ ComPensATion CoveRAge
* DATe of biRTh ReQuiReD only if APPlying foR A CigAReTTe wholesAle DeAleR’s liCense, A smAll gAmes of ChAnCe DisTRibuToR liCense, oR A smAll gAmes of ChAnCe mAnufACTuReR CeRTifiCATe.
SECTION 7 – ESTABLISHMENT BUSINESS ACTIVITY INFORMATION
REFER TO THE INSTRUCTIONS ON PAGES 20 & 21 TO COMPLETE THIS SECTION. COMPLETE SECTION 17 FOR MULTIPLE ESTABLISHMENTS.
1.enTeR The PeRCenTAge ThAT eACh PABUSINESS ACTIVITY RePResenTs of The ToTAl ReCeiPTs oR Revenues AT THIS esTAblishmenT. lisT PRODUCTS OR SERVICES AssoCiATeD wiTh eACh business ACTiviTy AnD The PeRCenTAge RePResenTing The ToTAl ReCeiPTs oR Revenues.
PA BUSINESS ACTIVITY |
% |
PRODUCTS OR SERVICES |
% |
ADDITIONAL |
% |
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PRODUCTS OR SERVICES |
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Accommodation & food services
Agriculture, forestry, fishing, & hunting
Art, entertainment, & Recreation services
Communications/information
Construction (must complete question 3)
Domestics (Private households)
educational services
finance
health Care services
insurance
management, support & Remediation services
manufacturing |
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mining, Quarrying, & oil/gas extraction |
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other services |
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Professional, scientific, & Technical services |
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Public Administration |
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Real estate |
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Retail Trade |
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sanitary service |
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social Assistance services |
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Transportation |
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utilities |
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warehousing |
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wholesale Trade |
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ToTAl |
100% |
2.enTeR The PeRCenTAge ThAT THIS ESTABLISHMENT’S ReCeiPTs oR Revenues RePResenT of The TOTAL PAReCeiPTs oR Revenues of The enTeRPRise.
______________ %. single esTAblishmenT enTeRPRises enTeR 100%. mulTiPle esTAblishmenT enTeRPRises enTeR PeRCenTAge of enTeRPRise (see seCTion 17).
3.esTAblishmenTs engAgeD in ConsTRuCTion MUST enTeR The PeRCenTAge of ConsTRuCTion ACTiviTy ThAT is new AnD/oR RenovATive AnD The PeRCenT- Age of ConsTRuCTion ACTiviTy ThAT is ResiDenTiAlAnD/oR CommeRCiAl.
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___________________ % new |
+ |
__________________ % RenovATive |
= |
100% |
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___________________ % ResiDenTiAl |
+ |
__________________ % CommeRCiAl |
= |
100% |
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4. o yes o no |
Does This enTeRPRise wAnT To beCome A PennsylvAniA loTTeRy ReTAileR? |
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5
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DePARTmenT use only |
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enTeRPRise nAme |
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SECTION 8 – ESTABLISHMENT SALES INFORMATION
1. |
o yes |
o no |
is This esTAblishmenT selling TAxAble PRoDuCTs oR offeRing TAxAble seRviCes To ConsumeRs fRom A loCATion |
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IN PENNSYLVANIA? if yes, ComPleTe seCTion 18. |
2. |
o yes |
o no |
is This esTAblishmenT selling CigAReTTes IN PENNSYLVANIA? if yes, ComPleTe seCTions 18 AnD 19. |
3. lisT eACh CounTy IN PENNSYLVANIA wheRe This esTAblishmenT is ConDuCTing TAxAble sAles ACTiviTy(ies).
CounTy |
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CounTy |
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CounTy |
CounTy |
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CounTy |
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CounTy |
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ATTACH ADDITIONAL 8 1/2 X 11 SHEETS IF NECESSARY. |
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SECTION 9 – ESTABLISHMENT EMPLOYMENT INFORMATION
PART 1
1. o yes o
2. o yes o
no |
Does This esTAblishmenT emPloy inDiviDuAls who WORK IN PENNSYLVANIA? if yes, inDiCATe: |
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a. |
DATe wAges fiRsT PAID (mm/DD/yyyy) |
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b. |
. . . . .DATe wAges ResumeD following A bReAK in emPloymenT |
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. |
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c. |
. . . . .ToTAl numbeR of emPloyees |
. . |
. |
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d. |
. . . . .numbeR of emPloyees PRimARily woRKing in new builDing oR infRAsTRuCTuRe |
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. |
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e. |
. . . . .numbeR of emPloyees PRimARily woRKing in RemoDeling ConsTRuCTion |
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. |
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f. |
esTimATeD gRoss wAges PeR QuARTeR |
.$ |
.00 |
g.nAme of woRKeRs’ ComPensATion insuRAnCe ComPAny
1. PoliCy numbeR _________________________________effeCTive sTART DATe __________________enD DATe ___________________
2. AgenCy nAme ______________________________________________________DAyTime TelePhone numbeR ( )
mAiling ADDRess _____________________________________CiTy/Town ______________________sTATe _____ZiP CoDe + 4________
3.if This enTeRPRise Does noT hAve woRKeRs’ ComPensATion insuRAnCe, CheCK one:
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a. |
This esTAblishmenT emPloys only exCluDeD woRKeRs |
o |
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b. |
. . . . . . . . .This esTAblishmenT hAs ZeRo emPloyees |
o |
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c. |
This esTAblishmenT ReCeiveD APPRovAl To |
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woRKeRs’ ComPensATion |
o |
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if iTem 3c. is CheCKeD, PRoviDe PA woRKeRs’ ComPensATion buReAu CoDe |
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no |
Does This esTAblishmenT emPloy PA ResiDenTs who WORK OUTSIDE OF PENNSYLVANIA? |
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if yes, inDiCATe: |
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a. |
DATe wAges fiRsT PAID (mm/DD/yyyy) |
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b. |
. . . . . . . . . .DATe wAges ResumeD following A bReAK in emPloymenT |
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c. |
esTimATeD gRoss wAges PeR QuARTeR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ |
.00 |
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3. |
o yes |
o no |
Does This esTAblishmenT PAy RemuneRATion foR seRviCes To PeRsons you Do noT ConsiDeR emPloyees? |
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if yes, exPlAin The seRviCes PeRfoRmeD |
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4. |
o yes |
o no |
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PART 2 |
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1. |
o yes |
o no |
is This RegisTRATion A ResulT of A TAxAble DisTRibuTion fRom A benefiT TRusT, DefeRReD PAymenT, oR ReTiRemenT PlAn |
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foR PA ResiDenTs? |
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if yes, inDiCATe: a. |
DATe benefiTs fiRsT PAID (mm/DD/yyyy) |
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b. |
esTimATeD benefiTs PAiD PeR QuARTeR |
$ |
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.00 |
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SECTION 10 – BULK SALE/TRANSFER INFORMATION
if AsseTs weRe ACQuiReD in bulK fRom moRe ThAn one enTeRPRise, PhoToCoPy This seCTion AnD PRoviDe The following infoRmATion AbouT eACh selleR/TRAnsfeRoR.
1. |
o yes |
o no |
DiD The enTeRPRise ACQuiRe 51% oR moRe of ANY CLASS of The PA ASSETS of AnoTheR enTeRPRise? see The ClAss of AsseTs |
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lisTeD below. |
2. |
o yes |
o no |
DiD The enTeRPRise ACQuiRe 51% oR moRe of The TOTALASSETS of AnoTheR enTeRPRise? |
if The AnsweR To eiTheR QuesTion is yes, PRoviDe The following infoRmATion AbouT The SELLER/TRANSFEROR. |
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3. |
selleR/TRAnsfeRoR nAme |
4. feDeRAl ein |
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5. selleR/TRAnsfeRoR sTReeT ADDRess
CiTy/Town
sTATe
ZiP CoDe + 4
6. DATe AsseTs ACQuiReD
7. AsseTs ACQuiReD: |
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o ACCounTs ReCeivAble |
o eQuiPmenT |
o invenToRy |
o nAme AnD/oR gooDwill |
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o ConTRACTs |
o fixTuRes |
o leAses |
o ReAl esTATe |
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o CusTomeRs/ClienTs |
o fuRniTuRe |
o mAChineRy |
o oTheR |
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IMPORTANT: IF, IN ADDITION TO ACQUIRING ASSETS IN BULK, THE ENTERPRISE ALSO ACQUIRED ALL OR PART OF A PREDECESSOR'S BUSINESS, SECTION 14 MUST BE COMPLETED.
IF THE ENTERPRISE IS ACQUIRING 51% OR MORE OF ANY CLASS OF PA ASSETS AND/OR 51% OF THE TOTAL ASSETS OF ANOTHER ENTERPRISE THE SELLER MUST OBTAIN A BULK SALE CLEARANCE CERTIFICATE. REFER TO INSTRUCTIONS ON PAGE 22.
6
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DePARTmenT use only |
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enTeRPRise nAme |
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SECTION 11 – CORPORATION INFORMATION
1. DATe of inCoRPoRATion |
2. sTATe of inCoRPoRATion |
3. CeRTifiCATe of AuThoRiTy DATe |
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4. CounTRy of inCoRPoRATion
5. o yes |
o no |
is This CoRPoRATion's sToCK PubliCly TRADeD? |
6. CheCK The APPRoPRiATe box(es) To DesCRibe This CoRPoRATion:
CoRPoRATion: o sToCK |
o PRofessionAl |
bAnK: o sTATe |
muTuAl ThRifT: o sTATe |
insuRAnCe |
o PA |
o |
o CooPeRATive |
o feDeRAl |
o feDeRAl |
ComPAny: |
o |
o mAnAgemenT |
o sTATuToRy Close |
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7. s CoRPoRATion: o feDeRAl |
inACCoRDAnCe wiThACTno.67 of 2006, A CoRPoRATion wiTh feDeRAl |
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PoRATion. in oRDeR NOT To be TAxeD As A PA s CoRPoRATion, |
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WWW.REVENUE.STATE.PA.US, foRms AnD PubliCATions, CoRPoRATion TAx. |
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COMPLETING THIS FORM WILL NOT FULFILL THE REQUIREMENT TO REGISTER FOR CORPORATE TAXES. REGISTERING CORPORATIONS MUST CONTACT THE PA DEPART- MENT OF STATE TO SECURE CORPORATE NAME CLEARANCE AND REGISTER FOR CORPORATION TAX PURPOSES. CONTACT THE PA DEPARTMENT OF STATE AT (717) 787- 1057, OR VISIT www.paopenforbusiness.state.pa.us.
SECTION 12 – REPORTING & PAYMENT METHODS
1.The DePARTmenT of Revenue ReQuiRes ThAT Any enTeRPRise mAKing PAymenTs eQuAl To oR gReATeR ThAn $20,000 RemiT PAymenTs viA one of The fol- lowing eleCTRoniC meThoDs: eleCTRoniC funDs TRAnsfeR (efT); eleCTRoniC TAx infoRmATion AnD DATA exChAnge sysTem
a. o yes |
o |
b. o yes |
o |
2. o yes |
o |
no |
Does This enTeRPRise meeT The DePARTmenT of Revenue’s ReQuiRemenTs foR eleCTRoniC PAymenTs? |
no |
Does This enTeRPRise wAnT To PARTiCiPATe in The DePARTmenT of Revenue’s eleCTRoniC PRogRAms? |
no |
if This enTeRPRise is A |
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inTeResTeD in ReCeiving infoRmATion AbouT The DePARTmenT of lAboR & inDusTRy’s oPTion of finAnCing uC CosTs |
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unDeR The ReimbuRsemenT meThoD in lieu of The ConTRibuToRy meThoD? foR moRe DeTAils, RefeR To seCTion 12 |
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insTRuCTions. |
The DePARTmenT of lAboR & inDusTRy ReQuiRes ThATAny enTeRPRise wiTh 250 oR moRe wAge enTRies PeR QuARTeRly RePoRT, file The wAge infoRmATion viA mAgneTiC meDiA. Any mAgneTiC RePoRTing file musT be submiTTeD foR ComPATibiliTy wiTh The DePARTmenT of lAboR & inDusTRy’s foRmAT. ConTACT The mAg- neTiC meDiA RePoRTing uniT AT (717)
The CommonweAlTh sTRongly ReCommenDs ThAT enTeRPRises use eleCTRoniC filing AnD PAymenT oPTions foR CeRTAin PennsylvAniA TAxes AnD seRviCes. infoRmATion AbouT inTeRneT filing oPTions CAn be founD on The
SECTION 13 – GOVERNMENT STRUCTURE
1. |
is The enTeRPRise A: |
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o goveRnmenT boDy |
o goveRnmenT owneD enTeRPRise |
o goveRnmenT & PRivATe seCToR |
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owneD enTeRPRise |
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2. |
is The goveRnmenT: |
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o DomesTiC/usA |
o |
o |
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3. |
if DomesTiC, is The goveRnmenT: |
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o feDeRAl |
loCAl: o CounTy |
o boRough |
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o sTATe goveRnoR's JuRisDiCTion |
o CiTy |
o sChool DisTRiCT |
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o sTATe |
o Town |
o oTheR |
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o TownshiP |
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DePARTmenT use only |
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enTeRPRise nAme |
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SECTION 14 – PREDECESSOR/SUCCESSOR INFORMATION
COMPLETE THIS SECTION IF THE REGISTERING ENTERPRISE IS WHOLLY OR PARTIALLY SUCCEEDING A PREDECESSOR.
FOR ASSISTANCE, CONTACT THE NEAREST DEPARTMENT OF LABOR & INDUSTRY FIELD ACCOUNTING SERVICE OFFICE.
if The enTeRPRise hAs moRe ThAn one PReDeCessoR, PhoToCoPy This PAge To PRoviDe The following infoRmATion AbouT eACh.
1. PReDeCessoR legAl nAme |
2. PReDeCessoR PA uC ACCounT numbeR |
3. PReDeCessoR TRADe nAme
4. PReDeCessoR feDeRAl ein
5. PReDeCessoR sTReeT ADDRess
CiTy/Town
sTATe
ZiP CoDe + 4
6. |
sPeCify how The business wAs ACQuiReD: |
o PuRChAse |
o ChAnge in legAl sTRuCTuRe |
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o ConsoliDATion |
o gifT |
o meRgeR |
o iRC seC. 338 eleCTion |
o oTheR (sPeCify) |
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7. |
o ACQuisiTion DATe |
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8. |
PeRCenTAge of The PReDeCessoR's ToTAl business (PAAnD |
% |
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9. |
PeRCenTAge of The PReDeCessoR's PA business ACQuiReD |
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% |
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if less ThAn 100%, PRoviDe The nAme(s) AnD ADDRess(es) of The esTAblishmenT(s) ThAT ConDuCTeD oPeRATions in PA oR emPloyeD PA ResiDenTs. |
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ATTACh ADDiTionAl 8 1/2 x 11 sheeTs if neCessARy. |
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nAme of esTAblishmenT(s) |
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ADDRess(es) |
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10.whAT wAs The PReDeCessoR’s business ACTiviTy in The PA business ThAT wAs ACQuiReD?
11. AsseTs ACQuiReD: |
o ACCounTs ReCeivAble |
o eQuiPmenT |
o leAses |
o oTheR (sPeCify) |
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o ConTRACTs |
o fixTuRes |
o mAChineRy |
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o CusTomeRs/ClienTs |
o fuRniTuRe |
o nAme AnD/oR gooDwill |
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o emPloyees |
o invenToRy |
o ReAl esTATe |
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12.o yes |
o no |
hAs The PReDeCessoR CeAseD PAying wAges in PA? if yes, enTeR The DATe PA wAges CeAseD, |
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if Known. |
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13.o yes |
o no |
hAs The PReDeCessoR CeAseD oPeRATions in PA? if yes, enTeR The DATe PA oPeRATions CeAseD, |
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if Known. |
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if no, DesCRibe The PReDeCessoR's PResenT PA business ACTiviTy, if Known. |
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14. AT The Time of TRAnsfeR fRom The PReDeCessoR enTeRPRise To The RegisTeRing enTeRPRise:
a. o yes |
o no |
weRe Any of The owneRs, shAReholDeRs (5% oR gReATeR), PARTneRs, offiCeRs, oR DiReCToRs of The PReDeCessoR |
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oR of Any AffiliATe, subsiDiARy oR PARenT CoRPoRATion of The PReDeCessoR Also owneRs, shAReholDeRs (5% oR |
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gReATeR), PARTneRs, offiCeRs, oR DiReCToRs of The RegisTeRing enTeRPRise oR of Any AffiliATe, subsiDiARy oR |
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PARenT CoRPoRATion of The RegisTeRing enTeRPRise? |
b. o yes |
o no |
wAs The PReDeCessoR, oR Any AffiliATe, subsiDiARy oR PARenT CoRPoRATion of The PReDeCessoR, An owneR, |
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shAReholDeR (5% oR gReATeR), oR PARTneR in The RegisTeRing enTeRPRise? |
c. o yes |
o no |
wAs The RegisTeRing enTeRPRise, oR Any AffiliATe, subsiDiARy oR PARenT CoRPoRATion of The RegisTeRing |
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enTeRPRise, An owneR, shAReholDeR (5% oR gReATeR), oR PARTneR in The PReDeCessoR? |
if The AnsweR To Any of The QuesTions in 14 is yes, PRoviDe The following infoRmATion. ATTACh ADDiTionAl 8 1/2 x 11 sheeTs if neCessARy.
liDenTify Those PeRsons AnD enTiTies by TheiR full nAme;
lDesCRibe TheiR RelATionshiP To The PReDeCessoR AnD Any AffiliATe, subsiDiARy AnD PARenT CoRPoRATion of The PReDeCessoR; AnD
lDesCRibe TheiR RelATionshiP To The RegisTeRing enTeRPRise AnD Any AffiliATe, subsiDiARy AnD PARenT CoRPoRATion of The RegisTeRing enTeRPRise.
The RegisTeRing enTeRPRise mAy APPly foR A TRAnsfeR in whole oR in PART of The PReDeCessoR's unemPloymenT ComPensATion (uC) exPeRienCe ReCoRD AnD ReseRve ACCounT bAlAnCe, if The RegisTeRing enTeRPRise is ConTinuing essenTiAlly The sAme business ACTiviTy As The PReDeCessoR AnD boTh PRoviDeD PA CoveReD emPloymenT. ComPleTe seCTion 15 AnD, if APPliCAble, seCTion 16.
noTe: A RegisTeRing enTeRPRise mAy APPly The uC TAxAble wAges PAiD by A PReDeCessoR TowARD The RegisTeRing enTeRPRise’s uC TAxAble wAge bAse foR The CAlenDAR yeAR of ACQuisiTion wiThouT TRAnsfeRRing The PReDeCessoR's exPeRienCe ReCoRD AnD ReseRve ACCounT bAlAnCe.
8
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DePARTmenT use only |
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enTeRPRise nAme |
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SECTION 15 – APPLICATION FOR PA UC EXPERIENCE RECORD |
AND |
RESERVE ACCOUNT |
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BALANCE OF PREDECESSOR |
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A RegisTeRing enTeRPRise mAy APPly The unemPloymenT ComPensATion (uC) TAxAble wAges PAiD by A PReDeCessoR TowARD The RegisTeRing enTeRPRise’s uC TAxAble wAge bAse foR The CAlenDAR yeAR of ACQuisiTion wiThouT TRAnsfeRRing The PReDeCessoR's exPeRienCe ReCoRD AnD ReseRve ACCounT bAlAnCe.
RefeR To The insTRuCTions To DeTeRmine if iT is ADvAnTAgeous To APPly foR A PReDeCessoR's uC exPeRienCe ReCoRD AnD ReseRve ACCounT bAlAnCe.
IMPORTANT: This APPliCATion CAnnoT be ConsiDeReD unless iT is signeD by An AuThoRiZeD signAToRy of boTh The PReDeCessoR AnD The RegisTeRing enTeRPRise. The TRAnsfeR in whole oR in PART of The exPeRienCe ReCoRD AnD ReseRve ACCounT bAlAnCe is binDing AnD iRRevoCAble onCe iT hAs been APPRoveD by The DePARTmenT of lAboR AnD inDusTRy.
APPliCATion is heReby mADe by The PReDeCessoR AnD The RegisTeRing enTeRPRise foR A TRAnsfeR To The RegisTeRing enTeRPRise of The PennsylvAniA unemPloymenT ComPensATion exPeRienCe ReCoRD AnD ReseRve ACCounT bAlAnCe of The PReDeCessoR wiTh ResPeCT To The TRAnsfeR.
we heReby CeRTify ThAT The TRAnsfeR RefeRenCeD in seCTion 14 hAs oCCuRReD As DesCRibeD TheRein AnD ThAT The RegisTeRing enTeRPRise is ConTinuing essenTiAlly The sAme business ACTiviTy As The PReDeCessoR. we Also heReby CeRTify ThAT The TRAnsfeR RefeRenCeD in seCTion 14 wAs noT unDeRTAKen PRimARily To obTAin A loweR uC TAx RATe, buT hAD A legiTimATe business PuRPose unRelATeD To unemPloymenT ComPensATion TAxes.
ComPleTe This seCTion only if you wAnT To APPly foR The PReDeCessoR’s exPeRienCe ReCoRD AnD ReseRve ACCounT bAlAnCe.
1. PReDeCessoR nAme |
DATe |
AuThoRiZeD signATuRe
TyPe oR PRinT nAme
TiTle
2. RegisTeRing enTeRPRise nAme
DATe
AuThoRiZeD signATuRe
TyPe oR PRinT nAme
TiTle
SECTION 16 - UNEMPLOYMENT COMPENSATION PARTIAL TRANSFER INFORMATION
ComPleTe This seCTion if The RegisTeRing enTeRPRiseACQuiReD only PART of The PReDeCessoR's PennsylvAniA(PA) businessAnD is mAKingAPPliCATion foR The TRAnsfeR of A PoRTion of The PReDeCessoR's exPeRienCe ReCoRD AnD ReseRve ACCounT bAlAnCe.
COMPLETE REPLACEMENT
UNEMPLOYMENT COMPENSATION (UC) TAXABLE WAGES ARe Those wAges ThAT Do noT exCeeD The uC TAxAble wAge bAse APPliCAble To A given CAlenDAR yeAR.
1.DATe wAges fiRsT PAiD by PReDeCessoR oR
2.enTeR The numbeR of emPloyees who woRKeD in THE PART OF THE BUSINESS OR WORKFORCE THAT WAS TRANSFERRED foR eACh QuARTeR in The TAble below. if no emPloymenT wAs given in Any QuARTeR, enTeR “0”.
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yeAR________ |
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yeAR________ |
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yeAR________ |
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yeAR________ |
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yeAR________ |
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yeAR________ |
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of TRAnsfeR |
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QuARTeRs |
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QuARTeRs |
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QuARTeRs |
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QuARTeRs |
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QuARTeRs |
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QuARTeRs |
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3.enTeR The numbeR of emPloyees who woRKeD in THE ENTIRE BUSINESS foR eACh QuARTeR in The TAble below. if no emPloymenT wAs given in Any QuARTeR, enTeR “0”.
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yeAR________ |
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yeAR________ |
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yeAR________ |
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yeAR________ |
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yeAR________ |
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yeAR________ |
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of TRAnsfeR |
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QuARTeRs |
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QuARTeRs |
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QuARTeRs |
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QuARTeRs |
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QuARTeRs |
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QuARTeRs |
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4.if The PART OF THE BUSINESS OR WORKFORCE THAT WAS TRANSFERRED wAs in exisTenCe foR less ThAn ThRee full CAlenDAR yeARs PRioR To The yeAR of TRAnsfeR, enTeR The following:
A. |
ToTAl numbeR of emPloyees who eARneD TAxAble wAges in The PART OF THE BUSINESS OR WORKFORCE THAT WAS TRANSFERRED DuRing The PeRioD |
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fRom The fiRsT DAy of The QuARTeR of TRAnsfeR To The DATe of TRAnsfeR |
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b. |
ToTAl numbeR of emPloyees who eARneD TAxAble wAges in The ENTIRE BUSINESS DuRing The PeRioD fRom The fiRsT DAy of The QuARTeR of |
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TRAnsfeR To The DATe of TRAnsfeR |
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5.PReDeCessoR's enTiRe PA uC TAXABLE PAyRoll, foR The PeRioD fRom The fiRsT DAy of The QuARTeR of TRAnsfeR To The DATe of TRAnsfeR ____________________________.
9
Form Information
| Fact Name | Fact Details |
|---|---|
| Purpose | The PA-100 form is used by enterprises to register for various taxes and services administered by the Pennsylvania Department of Revenue and the Department of Labor & Industry. |
| Eligibility | Any individual or organization, including sole proprietorships, partnerships, corporations, and government entities, may complete the PA-100 form if they are subject to Pennsylvania laws and pay wages to employees. |
| Sections Required | New registrants must complete all items in sections 1 through 10. Previously registered enterprises need to fill out sections 1 through 6 and any additional sections as necessary. |
| Mailing Address | Completed forms must be mailed to the Pennsylvania Department of Revenue, Bureau of Business Trust Fund Taxes, PO Box 280901, Harrisburg, PA 17128-0901. |
| Governing Laws | The PA-100 form is governed by Pennsylvania state laws related to business registration and taxation, specifically those administered by the Department of Revenue and the Department of Labor & Industry. |