CITY OF BIG RAPIDS EMPLOYER REGISTRATION 
IF YOU SUBMIT CITY OF BIG RAPIDS INCOME TAX WITHHOLDING YOU MUST COMPLETELY FILL THIS REGISTRATION FORM OUT 
BUSINESS NAME:                                                             FEIN/SSN: 
DBA NAME (IF DIFFERENT FROM ABOVE): 
NAME & FEIN/SSN INCOME TAX RETURN IS FILED UNDER: 
MAILING ADDRESS: 
LOCAL ADDRESS (IF APPLICABLE): 
TELEPHONE NUMBER: 
PRINCIPAL BUSINESS ACTIVITY: 
TYPE OF ORGANIZATION (PLEASE CIRCLE): 

                     SOLE PROPRIETORSHIP          PARTNERSHIP       CORPORATION                    NON-PROFIT 
                     (FILES SCHEDULE C)           (FILES FORM 1065) (FILES FORM 1120)              (DOES NOT FILE) 

NAME & SSN OF OWNER: 
(OR PARTNERS IF INCOME IS CLAIMED ON INDIVIDUAL RETURN) 
DATE BUSINESS WAS ACQUIRED: 
WAS THE BUSINESS PREVIOUSLY OPERATED BY ANOTHER EMPLOYER?             YES             NO 
PREVIOUS OWNER NAME AND FEIN/SSN (IF KNOWN): 
SIGNATURE:                            TITLE:                               DATE: 
                 COMPLETE THIS SECTION ONLY IF YOU ARE SUBJECT TO CITY OF BIG RAPIDS WITHHOLDING 

BUSINESS WITHHOLDING NAME AND FEIN: 
TAXABLE YEAR:                                                              NUMBER OF EMPLOYEES: 
DATE FIRST WAGES PAID THAT ARE SUBJECT TO BIG RAIDS WITHHOLDING: 

RETURN TO: CITY OF BIG RAPIDS, INCOME TAX OFFICE, 226 NORTH MICHIGAN AVENUE, BIG RAPIDS, MI  49307