EMPLOYER’S FEDERAL IDENTIFICATION NUMBER
GR-SS-4         CITY OF GRAYLING INCOME TAX DIVISION                                                              (IF NOT REQUIRED - WRITE “NONE”)
                 EMPLOYER’S WITHHOLDING REGISTRATION                                                              G.
                              READ INSTUCTIONS ON THE REVERS BEFORE FILLING OUT THIS FORM
1. BUSINESS NAME                                                                           3. MAILING ADDRESS

2. EMPLOYER’S NAME (GIVE OWNER’S TRUE NAME IF DIFFERENT FROM BUSINESS  NAME ABOVE)         4. ADDRESS OF PRINCIPAL PLACE OF BUSINESS

5. CHECK TYPE OF ORGANIZATION                                                            OTHER               6. LOCAL TELEPHONE NO.               7. NO. OF EMPLOYEES
❒ INDIVIDUAL OWNERS    ❒ PARTNERSHIP     ❒ CORPORATION    ❒ (ATTACH EXPLANATION)
8. DATE BUSINESS ACQUIRED BY   MONTH     DAY                   YEAR 9. GIVE THE DATE YOU FIRST PAID WAGES                                  MONTH          DAY          YEAR
EMPLOYER SHOWN IN ITEM 2 ABOVE                                                     SUBJECT TO GRAYLING WITHHOLDING
10. WAS THIS BUSINESS PREVIOUSLY OPERATED BY ANOTHER EMPLOYER?      11. ACCOUNTING PERIOD
GIVE EMPLOYER’S NAME                                                                     ❒ CALENDAR YEAR          ❒ FISCAL YEAR ENDING_________________________________
                                                                                                                                           MONTH

                               SIGNATURE                                                                          TITLE                                   DATE 

                                                               Please complete and return to: 
                 City of Grayling Income Tax Division, PO BOX 515, Eaton Rapids, MI 48827-0515

                                                                    INSTRUCTIONS

  Each employer withholding City of Grayling Income Tax from an employee’s wages must 
 register with the City of Grayling Income Tax Division. For the convenience of the employer, the 
 Federal Identification Number (FEIN) assigned to the employer by the Federal District Director of 
 the Internal Revenue Service will be used for the City of Grayling Income Tax Division records. 
 If an employer does not have a Federal Identification Number at the time of filing the City of 
 Grayling Income Tax reports, application can be made to the Federal District Director of Internal 
 Revenue on Federal Form SS-4 for a number.