HomeMy WebLinkAbout2005-03-15 Fox Hollow East Employer ID No. ApplicationPr int Review IRS Form SS-4 I'.IN
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5SM4 Application for Employer Identification Number EIN
Form -- ...
Rev. December 20013 F o r use by employers, corporations, partnerships, trusts, estates, churches, 20_2494946
Department of the government agencies, Indian tribal entities, certain individuals, and others.)
Treasury See separate instructions for each line. 0- Keep a copy for your records. OMB No, 1545 -9043
Internal Revenue Service
1 Legal name of entity (or individual) for whom the EIN is being requested
Fox Hollow East Master Association
2 Trade name of business (if different from name on line 1) 3* Executor, trustee, "care of" name
Jeffre G Hause
4a* Mailing address (room, apt., suite no. and street, or P,O. box) 5a Street address (if different) (Do not enter a P.O. box)
1909 St Croix Trail North
4b* City, state, and ZIP code 5b City, state, and ZIP code
Stillwater MN 55082 -
6* County and state where principal business is located
County Washin ton State MN
7a Name of principal officer, general partner, grantor, owner, or trustor 7b SSN, ITIN, EIN
8a* Type of entity (check only one) Estate (SSN of decedent)
Sole Proprietor (SSN) F Plan administrator (SSN)
Partnership F Trust (SSN of grantor)
Corporation (enter form number to be filed) � F National Guard F State /local government
F Personal Service F Farmers' cooperative F Federal governmenUmilitary
F Church or church- controlled organization F REMIC F Indian tribal governmentfenterprises
Other nonprofit organization (specify) m Owners Association Group Exemption NO, (GEN) 1 0-
Other (specif )
8b If a corporation, name the state or foreign country State Foreign country
(if applicable) where incorporated MN
9* Reason for applying (check only one) Banking purpose (specify purpose) open deposit acco
Started new business (specify type) F Changed type of organization (specify new type) �
F Purchased going business
F Hired employees (Check the box and see line 12) F Created a trust (specify type) 0-
Compliance with IRS withholding regulations F Created a pension plan (specify type)
Other s ecif � 0-
10* Date business started or acquired (month, day, year) 11 Closing month of accounting year
NOV 24 2004
12 First date wages or annuities were paid or will be paid (month, day, year) Note:lf applicant is a withholding agent, enter date
income will first be paid to nonresident alien. (month, da , ear .............. . .
13 Highest number of employees expected in the next twelve months Note;lf the applicant Agriculture Household Other
does not expect to have any employees during the period, enter " -0 - .............. 111� 0 9 0
14* Check box that best describes the principal activity of your business F Health care & social assistance Y Wholesale- agenUbroker
Construction F Rental & leasing F Transportation & warehousing F Accommodation & food service F Wholesale -other
Real estate F Manufacturing F Finance & insurance F Retail
Other spec!) Owners Assoc
15* Indicate principal line of merchandise sold; specific construction work done; products produced; or services provided,
Operation & maintenance of commonly owned ropert
16a* Has the applicant ever applied for an employer identification number for this or any other business? ........... F Yes W No
Note If "Yes" please cam lete lines 16b and 16c
16b If you checked "Yes" on line 16a, give applicant's legal name and trade name shown on prior application if different from line 1 or 2 above.
Legal name
Trade name
16c Approximate date when, and city and state where, the application was filed. Enter previous employer identification number if known.
Approximate date when filed (month, day, year) City and state where filed Previous EIN
Complete section only if you want to authorize the named individual to receive the entity's EIN and answer questions about the completion of this form
Third Designee's name Designee's telephone number (in area code)
Party Try ,t Eickhoff
Designee Address and ZIP code ( J51 ) 439 - 2951
Designee's fax number (include area code}
6120 Oren Avenue North Stillwater MN 55082 - ( 651 ) 439 - 1417
Under penalties of perjury,l declare that I have examined this application , and to the best of my knowledge and belie`, it is true,
correct, and complete. Applicant's telephone number (include area code)
Name and title (type or print clearly)
Print Review IRS Farm SS-4 EIN
$,- Jeffrey G Hause President_
Signature �- Not Required Date March 15, 2065 GMT
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( 651 ) 439 - 8431
Applicant's fax number (include area code)
f 651 ) 439 - 5085
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