Form

ss-4
2010) I
o,the rreasury

(Rev January
Departmenr

(ro1.1t1e-

Application for Employer ldentification Number
K""O u
"oOV

OMB No. 1545-0003

|

by employers, goporgtions, partnerships, trusts, estates, churches. sovernment aienbies' tnoibn ridai i,iuiiii,'JJil"-ih'iiaiviouars, and others.) ror rour

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G

I

1

Legal name of entity lor individu"

r."ord

2

PattvsPacks
Trade name of business (if different t

"rn

n"rr,"

* i*
f

rf

3

Executor, administrator, trustee, ..care of,, nurne

-g

o

'i

ct

4b City,state,"nOZta@
Chicago,

123 Main Street, Unit 12

sa streetaddresstir@ 5b
City state, and ZIP code (if foreign, see instructions)

Patty Jones

o o

tL

60600

o.

uounry and state where principal business is located

Cook Countv. lL

7a

Name of responsible party

Patty Jones
rs rnrs applcauon ror a ttmited tiability company (LLC) {or a foreign equivalent)? Bc

7b

SSN, lTlN. or EIN

12345-678S

I

yes

8b

V] No

lf 8a is "Yes," enter the number of
LLC members

9a

was the LLC

Type of

in the United States?

Z I I I I ! 9b
10

"ntity

l"tt

Sot" proprietor {SSN)
Partnership

123i4si

6789

Corporation {enter form number to be filed) Personal service corporation

}

I I

Churcn or church-controlled organization nonprofit organization {specify) 9t|rer

>_

fl fl n [f

Estat* (SSN of decedent) Ptan administrator fftN) Trust filN of grantor) Nationat cuard
Furmeru,cooperative REMIC
E

I I
f]

Statellocal government
Federal government/military

lf a corporation, name the state or toreigncountry
(if applicable) where incorporated

lndiun tribal governmentslenterprises Number {GEN) if anv } Foreign country

Reason for apptying (check only one box)

n

StarteO new business (specify type)

>
.13.)

a
D
'11

Hired employees (Check the box and see line Compliance with IRS withholding regulations

I

n n n

T

Banking purpose (specify purpose) ) Changed type of organization {specify new type) Purchased going business Created a trust ispecify type) > Created a pension plan (specify type) month of n""e),

}

>

Date business started or acquired {month, day, Vurrt.

S"" i*tr*tioo,,
Gnt*

t3

01,2005
Highest number of employees expected in the next 12 months

year December

{.if

lf no employees expected, skip line 14.
Agricultural
Household Other
J

lf you expect your employment tax liability to be $1,000 or less in a full calendar year and want to file Form g44 annually instead of Forms 941 quarterlv, check here. (Your employment tax liability generally will be $1 ,000

FirstdatewageSorannuitieswerepaid(month,day,yea't.r,r"t..
nonresident alien (month, day, year)
.

I

construction

n

Rental

&leasing

I

Transportation&warehousinn

finance & jnsurance

n

A""or*odation&foodservice
Otner (spec,fy) ,.0*t" pro,

I

wholesale-other

Z

Retait

Backpacks

18

Has the anOfican

lf "Yes," write previous EIN here

)

;

Complete this section only ii you want t0 auth0rize

th, nu*
Designee's telephone number {include area code)

Third
Party Designee
Ulderpenaltiesolperjury,|declarethatlhaVeeXaminedthi.app|lca|0n.andtotnenesi

) Designee's tax number (include area code)

Name and titie (typ€ or print ctetrty)

> pattv

Applicant's telephone numbel {include area code}

JOneS Dxe

{)

>O

zo 01
cat. No.
16055N

Applicant's iax number $nclude area code)

For Privacy Act

Reduction Act Notice, see separate instructions.

rorm

SS-4

6ev

PAR

121-

FEtN Assignment

The attorney you work for recently asked you to sit in on a meeting with a new client, patty Jones, a sole proprietor whose business is growing and has recently hired 3 new employees. ln this meeting, you learned the following:

o o o o o o o o o

assumed name of pattyspacks out of her home. As of July 1, 2008, she has been making and selling her backpacks from a small retail store that she leases atr23 Main street, unit 12, chicago, lL 60600. Her fiscal year is January 1 through December 31.
As of July

PattV designs and sells one-of_a_kind backpacks. She's been doing this since January I,2oos as a sole proprietor, operating under the

I,2oO8, she has 3 employees who will each earn a starting salary of

Ssooo/year.

will be paid on the l-5th and 30th of each month, with the 1't paychecks having been delivered on 7/LS/2OO8..
Because Patty now has employees, your attorney advises her that she needs to apply the lnternal Revenue Service for an employer identification number (ElN). PattY will continue

Each employee

to

to be a sole proprietor (Patty Joners, d/b/a pattyspacks this is the entity for whom the FE|N is being requested.)
Patty's social security number is 123_45_67g9.

Your boss has asked you to prepare the Application for Employer ldentification Number. ln order to do this, you should locate the form on the IRS website and complete it directly online, with Patty's signature.