CITY OF LAPEER – INCOME TAX DIVISION 
 EMPLOYER WITHHOLDING REGISTRATION 
 
Business Name in City of Lapeer___________________________________ FEIN _______________________ 
 
Business Address in City of Lapeer _____________________________________________________________ 
 
Employer’s True Name (if different from above)___________________________________________________  
 
Mailing Address ______________________________________________________ 
 
City _________________________________________   State______________   Zip Code________________ 
                  Business 
Number of Employees ________ Local Telephone No __________________ Start Date  __________________ 
 
Individual ___________   Partnership ___________   Corporation __________   Other (Describe) ___________  
 
Contact Person __________________________ Title ____________________Telephone No._______________