CITY OF PONTIAC - DIRECTOR OF FINANCE - INCOME TAX DIVISION                                        EMPLOYER'S FEDERAL IDENTIFICATION NUMBER
                                                                                                                      (IF NOT REQUIRED - WRITE "NONE")
        EMPLOYER'S WITHHOLDING REGISTRATION FORM P-SS-4
              READ INSTRUCTIONS ON THE REVERSE BEFORE FILLING OUT THIS FORM                                                xx-xxxxxxx
                                                                                                                              -  
1. TRADE NAME                                                               ~ 
2. EMPLOYER'S NAME:
    (GIVE OWNER'S TRUE NAME IF DIFFERENT FROM TRADE NAME ABOVE)             ~ 

3. ADDRESS OF PRINCIPAL PLACE OF BUSINESS

4. CHECK TYPE OF ORGANIZATION                                                 OTHER                   5. LOCAL TELEPHONE #                    6. NO. OF EMPLOYEES
        INDIVIDUAL OWNER      PARTNERSHIP              CORPORATION            (ATTACH EXPLANATION)
7. DATE•BUSINESS ACQUIRED BY•      IMONTH      DAY•    YEAR        8. GIVE•THE DATE YOU FIRST PAID WAGESI                        IMONTHI           DAY   YEAR
    EMPLOYER SHOWN IN ITEM 2 ABOVE                                     SUBJECT TO PONTIAC WITHHOLDING                          ~1 
9.  WAS THIS BUSINESS PREVIOUSLY OPERATED+I BY ANOTHER EMPLOYER?   10.  IF ANSWER TO ITEM 9 IS "YES", GIVE EMPLOYER'S NAME AND IDENTIFICATION # IF KNOWN.
                      YES            NO
                   •               • 

        SIGNATURE                                                             TITLE                                                           DATE
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                                                                INSTRUCTIONS

             Each employer withholding City of Pontiac Income Tax from employees' wages should register 
        immediately with the City of Pontiac, Director of Finance, Income Tax Division.  For the 
        convenience of the employer, the Federal Employer Identification Number (FEIN) assigned to 
        the employer by the Internal Revenue Service will be used for the City of Pontiac Income Tax 
        Division records.  If an employer does not have a FEIN at the time of filing the City of Pontiac 
        Income Tax Reports, application can be made to the Internal Revenue Service on Federal Form 
        SS-4 for a number.

             The City of Pontiac will NOT send a confirmation that your registration has been received. 
        When payments are made, please make sure to include your FEIN on your check, and/or the 
        monthly/quarterly P-941 withholding form. These forms are available on our website at 

             When, for any reason, the FEIN is not required, an identification number will be assigned by 
        the City of Pontiac Income Tax Division.  If an employer is assigned a FEIN at a later date, he 
        must notify the City Income Tax Division of the FEIN assigned.  The employer will then be 
        notified to discontinue the City of Pontiac Identification Number and use the FEIN for all 

             Read the instructions for withholding in the City of Pontiac Income Tax Withholding Guide.

              Return this form by using only one of these following options:
              by mail to:            City of Pontiac; Income Tax Division; PO Box 530; Eaton Rapids, MI  48827-0530
              by fax to:             City of Pontiac; Income Tax Division; 517-441-9706
              by email to:           pontiactax@issi-central.com