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 OR WOULD LIKE TO WITHHOLD AS A NON-
                                                   RESIDENT EMPLOYER 
  
 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 PROCESSING CENTER, PO BOX 536, EATON RAPIDS, MI 48827-0536