FORM E-9                  COLLECTOR OF REVENUE - CITY OF ST. LOUIS - APPLICATION FOR EARNINGS TAX ACCOUNT
REV. 10/22                               Please type or print - send to Gregory F.X. Daly, Collector of Revenue, 1200 Market Street, Room 410, St. Louis, MO 63103
                                                                              Fax: (314) 622-4847   Email: Earningstaxcor@stlouis-mo.gov
Federal Employer ID Number or Social Security Number          Type of Organization: (Not for profit must supply copy of exemption certificate)
                                                              Individual Business or Professional Person                                Partnership Corporation
                                                              Not for Profit              Estate Other (specify)
True Name (If a Corporation or Partnership, please complete the back of this application)                                               Reason for applying: (check one)
                                                                                                                                        New Business
                                                                                                                                        Purchased Business
Trade Name (Enter name if different than line above)                                                                                    Withholding for City Resident Only
                                                                                                                                        Other (Specify)
Address of Principal Place of Business                        City, State, Zip Code                                                                 Telephone Number
                                                                                                                                                    (        )
Local Address (If different than above)                       City, State, Zip Code                                                                 Local Telephone Number (If Different)
                                                                                                                                                    (        )
Date acquired or started within the city  First date wages are to be paid:                Calendar Year                                             Type of Business
of St. Louis:
                                                                                          Fiscal Year Ending
Have you ever applied for an Earnings Tax Account for this or Print or Type Name of Owner  /Partner  /Officer                                           Title
any other business?   Yes    No (if Yes, enter FIDN or name)

Date          Signature                                       Social Security Number                                                    OFFICE USE ONLY:
                                                                                                                                        Approved by                     Date

List All Partners or Corporate Officers (Attach list if necessary)                      OFFICE USE ONLY
Name (Last, First, MI)                                             Title
Home Address                                                       City, State, Zip
Social Security Number                                             Home Telephone Number
Name                                                               Title
Home Address                                                       City, State, Zip
Social Security Number                                             Home Telephone Number
Name                                                               Title
Home Address                                                       City, State, Zip
Social Security Number                                             Home Telephone Number
Name                                                               Title
Home Address                                                       City, State, Zip
Social Security Number                                             Home Telephone Number
Name                                                               Title
Home Address                                                       City, State, Zip
Social Security Number                                             Home Telephone Number

                       ALL INFORMATION SUBJECT TO VERIFICATION