TABLE OF CONTENTS                     
   Introduction…………………………………………………………………………………………….…………... 1                                                                          
   Taxes of the State of New Jersey………………………………………………………………………….………..                                           2                     
   Instructions for Business Registration Application (NJ-REG)….……………….…………………………….…...  6                                            
   Business Registration Application (NJ-REG)……………………….……………………………….……...……...  17                                                    
   Instructions for Business Entity Public Record Filing…………………………………………………….………..  21                                                
   Business Entity Public Record Filing Application….…………………………………………………….………...  23                                                  
   Instructions for Registration of Alternate Name (C-150G)……………………………………………………........ 25                                            
   Registration of Alternate Name Application (C-150G).…………………………………………..……...………...  26                                              
   Instructions for New Hire Reporting………..………………………………………………………….…………..  27                                                          
   New Hire Reporting Form………………………………………………………………………………………….  29                                                                     
   Instructions for Business Change and Amendment Form (REG-C-L and REG-C-EA)………….……….………..  35                                       
   Request for Change of Registration Information Application (REG-C-L)………………………………………….  37                                          
   Business Entity Amendment Filing (REG-C-EA).………………………………………………..………………..  38                                                       
   New Jersey S Corporation & QSSS Election Form and Instructions (CBT-2553)………………..………………..  40                                      
   Instructions for New Jersey S Corporation Certification (CBT-2553 Cert)…………..……………………..……...  42                                   
   New Jersey S Corporation Certification Application (CBT-2553 Cert)………………………………………..........  43                                    
   Cigarette License Application (CM-100).…………………………………………………………………………..  44                                                          
    (Cigarette Retail, Vending & Manufacturer Representative Licenses)                                            
   Instructions for Motor Fuel License Application (MFA-1).………………………………………………………..                              45                    
    (Distributor, Permissive Supplier, Retail Dealer, Supplier, Terminal Operator and Transporter)                                    
   Motor Fuel License Application (MFA-1)………………………………………………………………………….  48

                                                 INTRODUCTION                                                                         
                     BUSINESS REGISTRATION  ORMSF                     AND  NFORMATIONI                    
   This packet contains information and forms  you  will need to  register your business with the  Division of Revenue and           
   Enterprise Services (DORES).  By completing and filing a Business Registration Application (NJ-REG), a business will be 
   registered  for  applicable taxes and  related liabilities that  are  administered by  the  Department of  Labor and Workforce 
   Development and Division of Taxation.  Businesses may register online or may submit form NJ-REG and if applicable, 
   the Public Records Filing for New Business Entity.   After registering, businesses will receive the forms, returns, instructions 
   and other information required for on-going compliance with New Jersey State taxes.  If you are registering for the first 
   time, you are also required to complete the New Hire Reporting Form (pages 29-30). 
    
   Applicants who    are   registering as Sole       Proprietors      or Partnerships may file            online              at 
   https://www.njportal.com/DOR/BusinessRegistration or may file         pages 17-19, form NJ-REG.  Applicants who are 
   registering a  new business entity  (Limited Liability Company, Limited Partnership, Limited  Liability Partnership, or  a 
   Corporation), and who have already formed a new business with our Commercial Recording/Corporate Filing Unit,   may 
   file online at https://www.njportal.com/DOR/BusinessRegistration       or may file pages 17-19, form NJ-REG.  There 
   is no need to complete pages 23-24 of this package if you have successfully filed with Commercial Recording.  Applicants 
   who are  registering  as a  new Business Entity  (Limited  Liability  Company,  Limited Partnership, Limited  Liability 
   Partnership, or a Corporation) may file online at https://www.njportal.com/DOR/BusinessFormation/Home/Welcome or 
   may complete  the Public Records  Filing for New Business Entity   pages 23-24 in addition to pages 17-19.  Please note 
   that the Public Records  Filing should be submitted prior to the completion of form NJ-REG, but form NJ-REG must be 
   submitted within 60 days of filing the new business entity. 
    
   Sales Tax?  If you will be collecting Sales Tax, you must submit your NJ-REG at least fifteen days prior to the date of 
   your first sale, remitting use tax, or using NJ exemption certificates.    You will receive a Certificate of Authority for 
   sales tax indicating the 12-digit identification number assigned to your business. 
    
   Federal Identification Number?    All  corporations  and  businesses  with  employees  must have a  Federal  Employer 
   Identification Number (FEIN).  You must apply for your FEIN after you have formed your business entity.  Contact the 
   Internal Revenue Service at 1-800-829-1040 or https://www.irs.gov. 
    
   Questions?  Please contact the DORES’ Customer Service Center at 609-292-9292 if you have questions regarding the 
   filing of the Business Registration Application or the Public Records Filing for New Business Entity. 

                                                               ‐ ‐ 1                                                                Revised 10/2021 
 

REG-3 
(10-2018)  
 
                                             TAXES OF THE STATE OF  EW N                   ERSEYJ            
                    The following outline provides basic information regarding taxes imposed by the State of New Jersey 
                    and administered by the Division of Taxation and the Division of    Revenue and Enterprise Services (DORES) 
                                       that a new business may be responsible for collecting and paying. 
 
NEW JERSEY GROSS INCOME TAX (N.J.S.A. 54A:1-1 et seq.)                         employment during some portion of a day in 20 different calendar weeks 
 Personal income tax is imposed on the New Jersey taxable income               within the calendar year or had a quarterly payroll of $1,500 or more. 
of resident and nonresident individuals, estates and trusts for taxable years  Note:   Agricultural  Employers – You are liable for contributions on 
ending on or after July 1, 1976.  Residents are subject to tax on all income,  wages paid to agricultural employees if: 
regardless of where it was earned, while nonresidents are only subject to       1.      You were already a registered employer, or 
tax on income derived from sources within New Jersey.                           2.      Not registered, you were or became subject to the law, having 
 The withholding requirements apply to every New Jersey employer                        paid wages of $1,000 or more in a calendar year to one or more 
making payment of taxable wages.  For New Jersey Gross Income Tax                       workers for services performed in a non-agricultural business 
purposes, the term “employer” includes organizations that may be exempt                 operation, or 
from Federal income tax or New Jersey Corporation Business Tax, such            3.      You acquired the organization, trade or business, or 
as religious organizations and governmental agencies.                                   substantially all the assets of an employing unit already subject 
 Generally, anything regarded as “wages” for Federal withholding                        to the law, or 
purposes is subject to withholding for the New Jersey Income Tax.  Every        4.      You are subject to the Federal Unemployment Tax Act, or 
taxpayer is required to file a quarterly return of tax withheld (NJ-927) for    5.      Not subject under the above provisions, you: 
each calendar quarter.  Some taxpayers are also required to file a monthly              a. Paid gross cash remuneration  of $20,000 or  more to 
remittance (NJ-500).  Taxpayers classified as “weekly payers” must remit                   individuals employed in  agricultural labor during any 
payment of withholdings by means of Electronic Funds Transfer (EFT)                        calendar quarter, or 
on the Wednesday of the week following the week in which the taxes were                 b. Employed ten or more individuals in agricultural labor, 
withheld.  Taxpayers not classified as weekly payers must remit the tax                    regardless of whether they were employed  at the same 
withheld with  their withholding return either monthly or quarterly,                       moment of time, for some portion of a day in each of 20 
depending on the amount of withholding liability.                                          different calendar weeks, whether or not such weeks were 
                                                                                           consecutive. 
RECIPROCAL AGREEMENT (NJ & PA Residents Only)                                   
 Under the Reciprocal Tax Agreement, the compensation derived by               SPECIAL EMPLOYERS – Under certain circumstances, a crew leader 
residents of either state (New Jersey or Pennsylvania) will be subject to      who provides a crew to an agricultural employer, can be considered the 
income tax only in the state of residence including compensation income        employer of the crew for unemployment tax purposes.  The agreement 
derived from sources within the other state.                                   between the crew leader and entity must comply with all Federal and State 
 Compensation that  is limited  to  the provisions  of the Reciprocal          regulations and the crew leader must be registered under the New Jersey 
Agreement means salaries, wages, tips, fees, commissions, bonuses and          Crew Leader Registration Act.   For further information  contact any 
other remuneration received for services rendered.   Businesses or             Regional Office. 
professional income earned by a resident of either state is not covered by      
the Reciprocal Agreement and is subject to the income tax of the state in      DOMESTIC EMPLOYERS – In order for you to become subject to the 
which it is earned.                                                            law, you must have paid gross cash wages of at least $1,000 to domestic 
                                                                               labor in a calendar quarter. 
UNEMPLOYMENT & DISABILITY TAXES – If you are employing,                         The State of New Jersey and its political subdivisions are subject to 
or expect to employ, one or more persons, you should notify DORES so           the law. 
that a determination can be made as to whether or not you are subject to        
the  law.   Under the law (N.J.S.A.  43:21-19(h1) et seq.)  it is  your        WITHHOLDING REQUIREMENT FOR UNREGISTERED, 
responsibility to make the fact known.                                         UNINCORPORATED CONTRACTORS (N.J.S.A. 54A:7-1) 
                                                                                All persons and businesses, other than governmental entities, 
DETERMINATION OF LIABILITY –                 If  you start  a business and     homeowners or tenants, maintaining an office or transacting business in 
employ one or more individuals and pay wages of $1,000 or more in a            New Jersey  and making payments  for services to unregistered, 
calendar year, you may be subject to the law.                                  unincorporated contractors – whether residents or nonresidents – must 
 If you acquire the organization, trade or business, or substantially all      withhold New Jersey Gross Income Tax at the rate of 7% of the amount 
the assets of an employing unit which is already subject to the law, you       paid.  More information on the Withholding Requirement for Contractor 
immediately become a subject employer.                                         Services is  available on the Division of  Taxation's website  at: 
 If you are subject to the provisions of the Federal Unemployment              https://www.state.nj.us/treasury/taxation/noticegit.shtml. 
Tax Act (FUTA), you automatically become subject under the law, unless          
the services performed are specifically excluded under the New Jersey          SET OFF OF INDIVIDUAL LIABILITY (N.J.S.A.  54A:9-7 et seq.) 
law.  An employing unit is generally subject to FUTA if it had covered          Public Laws of 1981, Chapter 239, provides the authority for the 
                                                                               New Jersey Department of Treasury to apply or cause to be applied any 
                                                           ‐ ‐ 2
 

monies due  a taxpayer as  a Gross Income Tax refund or Homestead            security services; information services; sales of restaurant meals and 
Property Tax Rebate, or both, if necessary, toward satisfaction of any       prepared food and beverages; hotel or motel room occupancies and other 
indebtedness that the taxpayer may have outstanding to any agency or         transient accommodation rentals (e.g., vacation rentals, houses, rooms, or 
institution of the New Jersey State Government or the Federal Internal       similar lodging  used on  a transient basis);  certain admission charges; 
Revenue Service.                                                             certain membership fees; parking charges; storage services; sales of 
                                                                             magazines and  periodicals; delivery charges; and  telecommunications 
CORPORATION BUSINESS TAX (N.J.S.A. 54:10A-1 et seq.)                         services, except as otherwise provided in the Sales and Use Tax Act. 
 The Corporation Business Tax Act imposes a franchise tax for the             A compensating use tax is also imposed when taxable property and 
privilege of having or exercising a corporate charter, deriving income or    services are purchased and New Jersey sales tax is either not collected or 
doing business, employing or owning capital or property or maintaining       is collected at a rate less than New Jersey’s sales tax rate. 
an office in New Jersey.  The tax also applies to foreign corporations        The Law exempts certain necessities such as  most food sold as 
falling into one of the following categories:                                grocery items, prescription drugs and most over-the-counter drugs, most 
       Holds a general Certificate of Authority issued by DORES to          clothing and footwear, and certain utilities such as water, steam, and fuel. 
        do business in New Jersey, or                                        In addition, there are tax exemptions for certain items and services when 
       Holds  a certificate, license,  or other authorization  issued by    used or consumed under specifically defined conditions or circumstances. 
        another New Jersey department or agency  authorizing it to            The sales tax is imposed on the consumer; however, anyone required 
        engage in business within New Jersey, or                             to collect Sales and Use Tax does so as a trustee on behalf of the State of 
       Employs or owns capital in New Jersey, or                            New Jersey and may be held personally liable for failure to collect the tax 
       Employs or owns property in New Jersey, or                           when required or for failure to file returns and remit any taxes due on a 
       Maintains an office in New Jersey, or                                timely basis. 
       Derives receipts from sources in New Jersey, or                       Businesses must file a quarterly return (Form ST-50) electronically, 
       Engages in contacts in New Jersey, or                                and some businesses may also have to file monthly returns (ST-51). 
                                                                              
       Does business in New Jersey. 
                                                                             SALEM COUNTY (N.J.S.A. 54:32B-8.45 et seq.) 
 Returns are required to be filed on or before the 15th day of the fourth 
                                                                              Certain sales made by  businesses located in Salem County  are 
month following the close of the taxpayer's accounting period. 
                                                                             taxable at a reduced sales tax rate. 
 Every corporation must, before commencing to do business in this 
                                                                              To qualify for  the rate, the sale must be made from a place  of 
State, obtain a Corporate Charter from DORES. 
                                                                             business regularly operated by the seller for the purpose of making retail 
 
                                                                             sales at which items are regularly exhibited and offered for retail sale and 
NEW JERSEY S CORPORATIONS 
                                                                             which is not utilized primarily for the purpose of catalogue or mail order 
 Chapter 173, P.L. 1993, provides that a corporation may elect to be 
                                                                             sales.  Also, merchandise must be ordered or picked up in person by the 
treated as a New Jersey S Corporation.  A corporation may make the 
                                                                             purchaser at the place of business in Salem County. 
election to be  treated  as a New Jersey S Corporation only if the 
                                                                              Salem County businesses must file a monthly return (Form ST-450) 
corporation is or will be an S Corporation pursuant to Section 1361 of the 
                                                                             electronically. 
Federal  Internal Revenue Code, and  each initial shareholder  of the 
                                                                              
corporation consents to the election and the jurisdiction requirements by 
submitting the S Corporation election form (CBT-2553).                       ATLANTIC CITY LUXURY SALES TAX 
                                                                             (N.J.S.A. 40:48-8.15 et seq.)  
 
                                                                              A tax is  applied to the receipts from specified retail sales within 
NOTICE OF BUSINESS ACTIVITIES REPORTING ACT 
                                                                             Atlantic City, including: 
(N.J.S.A. 14A:13-14 to 14A:13-23) 
 Foreign corporations which carry on any activity or own or maintain           Alcoholic beverages for on-premises consumption; 
any property  in this state, unless specifically  exempted, must file  an      Cover, minimum, entertainment or other similar charges 
annual Notice of Business Activities Report.  No report is necessary if the    Hotel or motel room occupancies  and other  transient 
foreign corporation has received a Certificate of Authority to do business      accommodation rentals (e.g., vacation rentals, houses, rooms, 
in New Jersey or has filed a timely  return  as required under the              or similar lodging that is used on a transient basis) 
Corporation Business Tax or the Corporation Income Tax Acts.                   Hiring of rolling chairs, beach chairs or cabanas; and 
 The failure of  a foreign  corporation  to file  a timely report may          Admission charges to any  theater, moving picture, pier, 
prevent the use of the courts in New Jersey for all contracts executed and      exhibition or place of amusement. 
all causes of action that arose at any time prior to the end of the last      Businesses must file a monthly return (Form ST-250) electronically. 
accounting period for which the corporation failed to file a required timely  
report.                                                                      CAPE MAY COUNTY TOURISM SALES TAX 
                                                                             (N.J.S.A. 40:54D-1 et seq.) 
CORPORATION BANKING AND FINANCIAL BUSINESS TAX                                The Tourism Improvement and Development District Act authorizes 
(N.J.S.A. 54:10A-1 et seq.)                                                  municipalities in Cape May to require certain businesses to collect an 
 Banking and financial businesses that operate as corporate entities         additional sales tax on predominantly tourism-related retail sales.  
are subject to the provisions of the New Jersey Corporation Business Tax     Tourism-related retail sales include admission charges to amusements; 
Act.  For a calendar year operation, a Banking and Financial Corporation     cover charges in nightclubs and cabarets; hotel or motel room occupancies 
Return (BFC-1) is due on the 15th day of April or the 15th day of the        and other transient accommodation rentals (e.g., vacation rentals, houses, 
fourth month after the close of the fiscal year.                             rooms, or similar lodging used on a transient basis); prepared food and 
                                                                             beverages sold in restaurants, or similar establishments or by caterers. 
SALES AND USE TAX (N.J.S.A. 54:32B-1 et seq.)                                 Businesses must file a monthly return (Form ST-350) electronically. 
 Sales tax is imposed on receipts from the retail sale, rental, or use of     
tangible personal property or specified digital products; retail sale of     URBAN ENTERPRISE ZONE (N.J.S.A. 52:27H-60 et seq.) 
producing, fabricating, processing, installing, maintaining, repairing, and   The Urban Enterprise Zone Act authorizes certain tax benefits for 
servicing tangible personal property  or specified digital products;         businesses designated as “qualified” by the Department of Commerce and 
maintaining, servicing, or repairing real property; certain mail processing  Economic Development.  These tax benefits are covered under the Sales 
services;  tattooing, tanning and massage services;  investigation and       and Use Tax Act and the Corporation Business Tax Act. 
                                                               ‐ ‐ 3
 

 Application can be made with DORES for these benefits only after             on the annual premium tax return.  A deduction for the amount of tax paid 
the business has been designated as  “qualified” by the Department of         directly to a firemen’s relief association(s) applicable to the calendar year 
Commerce and Economic Development.                                            covered by the annual premium tax return is allowed. 
                                                                                  A tax on the three year average underwriting profits on ocean marine 
STATE OCCUPANCY FEE AND MUNICIPAL OCCUPANCY                                   insurance is reported to the Commissioner of Insurance by April 1 of each 
TAX (N.J.S.A. 40:48E-1 et seq.)                                               year. 
 There is a State Occupancy Fee imposed on hotel or motel room                    A tax on premiums charged for surplus lines coverage is collected 
occupancies and other  transient  accommodation  rentals (e.g., vacation      from the insured by the surplus lines agent. 
rentals, houses, rooms, or similar lodging used on a transient basis) The         Insurance companies may also be subject to  retaliatory tax  under 
State Occupancy Fee is 5% except in the municipalities listed below:          certain provisions in the law (N.J.S.A. 17:32-15 and 17B:23-5). 
    Newark, Jersey City and Atlantic City – 1%                                
    Wildwood, Wildwood Crest and North Wildwood – 3.15%                      PUBLIC UTILITY FRANCHISE TAX (N.J.S.A. 54:30A-49 et seq.) 
 In addition, each municipality may adopt an ordinance imposing a                 The Public Utility Franchise and Gross Receipts Taxes apply  to 
Municipal Occupancy Tax which can be imposed at a rate of up to 3%.           persons, co-partnerships, associations, and corporations, other than those 
 Businesses must file a monthly return (HM-100) electronically.               specifically  exempted, operating as sewerage  or water  companies or 
                                                                              providing sewerage and water service in the state of New Jersey. 
ALCOHOLIC BEVERAGE TAX (N.J.S.A. 54:41-1 et seq.)                                 Inquiries concerning this tax should be directed to the Public Utility 
 The  Alcoholic Beverage Tax Act imposes taxes on  alcoholic                  Tax Section of the Division of Taxation at 609-633-2576. 
beverages.  The Alcoholic Beverage Tax is to be paid by manufacturers,         
wholesalers and other persons  licensed by  the  Division of Alcoholic        SPILL COMPENSATION AND CONTROL TAX 
Beverage Control.   Retail licenses  are authorized  and issued  by           (N.J.S.A. 58:10-23.11 et seq.) 
municipalities of New Jersey.                                                     The Spill Compensation and  Control  Tax is imposed upon the 
                                                                              transfer of petroleum products and other hazardous substances, as 
CIGARETTE TAX (N.J.S.A. 54:40A-1 et seq.)                                     determined by the New Jersey Department of Environmental Protection, 
 A tax is imposed on the sale, use or possession for sale or use within       within New Jersey. 
New Jersey of all cigarettes.  License fees are payable by distributors,            The tax is payable by: 
wholesalers, manufacturers, retailers and vending machine retailers.                a.           the operator or owner of the receiving major facility 
                                                                                                 or vessel on a transfer of a hazardous substance from 
MOTOR FUELS TAX (N.J.S.A. 54:39-101 et seq.)                                                     a major facility or vessel; or 
 The motor fuels tax is imposed on fuel used or consumed in New                     b.           the operator or owner of the transferring New Jersey 
Jersey.   The  motor fuels tax is  imposed on the  consumer, but is                              major facility on a transfer of a previously untaxed 
precollected pursuant to the terms of the “Motor Fuels Tax Act” P.L.                             nonpetroleum hazardous substance  to  a non-major 
2010, c.22 (C.54:39 101et seq.) for the facility and convenience of the                          facility; or 
consumer.                                                                           c.           the owner of a hazardous substance transferred to a 
                                                                                                 public storage  terminal  from a major facility or 
Note:    Motor Fuels Use Tax (N.J.S.A. 54:39A-101 et seq.)  is                                   vessel. 
administered by the New Jersey Division of Motor Vehicles and imposes             A major facility is a facility  with  a storage  capacity of 200,000 
a fuel use tax on certain commercial and omnibus vehicles.  This tax is       gallons or more for all hazardous substances, including petroleum 
based on the amount of motor fuels used in their operations within New        products, or a storage capacity of 20,000 gallons or more of nonpetroleum 
Jersey.  For further information, contact the New Jersey Division of Motor    hazardous substances. 
Vehicles, 20 S. Montgomery Street, Trenton, New Jersey 08660 or at:               The SCC-5 return is required to be filed on or before the 20th day of 
https://www.state.nj.us/mvc.                                                  each month for the preceding month’s hazardous substance transfers. 
                                                                               
INSURANCE PREMIUMS TAX                                                        LITTER CONTROL FEE (N.J.S.A. 13:1E-213 through 13:1E-223) 
(N.J.S.A. 54:16-1 et seq., 16A-1 et seq., 54:18A-1 et seq., 54:17-4 et seq.)      The Clean Communities and  Recycling Grant Act, imposes an 
 Insurance Premiums Tax applies to premiums collected on insurance            annual Litter Control Fee on all gross receipts from wholesale sales and 
risks in this State during the preceding calendar year.  The tax applies to   on all gross receipts from retail sales of litter-generating products sold 
every  stock, mutual and  assessment insurance  company organized or          within or into New Jersey by each person engaged in business in the State 
existing under any general or special law of this State or any other state    as a manufacturer, wholesaler, distributor, or retailer of such products. 
or foreign country transacting business in this State.                        Any retailer with less than $500,000 in annual retail sales of litter-
 Taxable premiums of life insurance companies include all gross               generating products or any “eat-in” restaurant (with take-out sales 
contract premiums except premiums for reinsurance and  annuity                less than 1/2 of all sales) is excluded from this fee for that calendar 
considerations, less certain specified deductions.   Non-life  companies      year.  Annual returns (LF-5) are required to be filed on or before March 
generally  are taxed upon gross premiums and assessments except               15 of each year. 
reinsurance premiums less certain deductions.                                     Litter-generating  products are:   beer and other malt beverages, 
 An annual premium tax return,  reporting the tax liability for the           cigarette and tobacco products, cleaning agents and toiletries, distilled 
preceding calendar year, must be filed and the tax paid by March 1 of each    spirits, food for human or pet consumption, glass containers sold as such, 
year.  The March 1 return must also include a prepayment of the current       groceries, metal containers sold as such, motor vehicle tires, newsprint 
year’s tax liability equivalent to 50% of the prior year’s tax liability.  An and magazine paper stock, nondrug drugstore  sundry products, paper 
additional prepayment of the current year’s liability, also equivalent to     products and household paper other than roll stock and wood pulp, plastic 
50% of the prior year’s tax liability, is due June 1 of each year.            or fiber containers made of synthetic material and sold as such, soft drinks 
 A tax on the premiums for fire insurance written by a company not            and carbonated waters, and wine. 
organized under the laws of New Jersey must be reported and paid to the        
treasurer of a duly incorporated firemen’s relief association in which the    SANITARY LANDFILL TAXES 
fire insurance risk is located by  March 1 of each  year,  covering the           All sanitary landfill taxes are reportable on one consolidated Sanitary 
preceding calendar year.  The company must also report these premiums         Landfill Tax Return (Form SLT-5). 

                                                                     ‐ ‐ 4
 

 The Consolidated Sanitary Landfill Tax Return (Form SLT-5) must             be included in the receipts subject to sales tax liability assessed pursuant 
be filed by the 20th day of the month following that in which tax liability  to the "Sales and Use Tax Act" P.L.1966, c.30 (C.54:32B-1 et seq.). 
was first incurred and monthly thereafter.                                       The fee must be reported on return form DSF-100 which is filed tele- 
LANDFILL CLOSURE AND CONTINGENCY TAX                                         phonically or by using an internet based application on the Division of 
(N.J.S.A. 13:1E-100 et seq.)                                                 Taxation website.  The quarterly return must be filed whether or not there 
 The Landfill Closure and Contingency Tax is levied upon the owner           are any fees due for the quarter. 
or operator of every sanitary landfill facility located in New Jersey on all     For more information, please see Technical Bulletin 47 (R2)  at: 
solid waste accepted for disposal.                                           https://www.state.nj.us/treasury/taxation/pdf/pubs/tb/tb47r2.pdf. 
 The Act also requires the sanitary landfill facility owner or operator       
to  establish an escrow account, administered by  the New Jersey             NEW JERSEY MOTOR VEHICLE TIRE FEE (N.J.S.A. 54:32F-1) 
Department of Environmental Protection, and to deposit into the account          As of August 1, 2004, a fee of $1.50 per tire is imposed on the retail 
$1.00 per ton of all solid waste accepted for disposal.                      sale of new motor vehicle tires, including tires that are a component part 
                                                                             of a motor vehicle that is sold or leased.  The Motor Vehicle Tire Fee is 
SOLID WASTE SERVICES TAX (N.J.S.A. 13:1E-138a)                               imposed on those transactions that are subject to the New Jersey Sales 
 The Solid Waste Services Tax is levied on the owner or operator of          Tax Act.   Thus, it  is  not imposed on sales made to  federal or  state 
every sanitary landfill facility in New Jersey on all solid waste accepted   governmental agencies and entities, qualified exempt organizations; sales 
for disposal.                                                                for an exempt use; sales to nonresidents.  See the Division of Taxation’s 
 The revenue collected from the Solid Waste Services Tax will be             September 9, 2004 Notice for  additional information  about the Motor 
deposited in the Solid Waste Services Tax fund to be administered by the     Vehicle Tire Fee and valid exemptions at:      
New Jersey Department of Environmental Protection.                           https://www.nj.gov/treasury/taxation/pdf/mvtirenotice.pdf. 
                                                                              
PETROLEUM PRODUCTS GROSS RECEIPTS TAX                                        9-1-1 SYSTEM AND EMERGENCY RESPONSE FEE 
(N.J.S.A. 54:15b-1 et seq.)                                                  (N.J.S.A. 52:17C-17 et seq.) 
 The Petroleum Products Gross Receipts Tax imposes a tax on (a) the               A $.90 fee is to be charged by: 
gross receipts derived or gallons sold from the first sale of petroleum           Mobile telecommunications companies for each voice grade 
products made to points in New Jersey, and (b) the dollar consideration            access service number as part of mobile telecommunications 
given or contracted to be given for petroleum products imported or caused          service provided to a customer billed by or for the customer's 
to be imported for use or consumption within New Jersey.                           home service provider and provided to a customer with a place 
 Receipts from (a) the sale of home heating oil and propane gas used               of primary use in this State, and 
exclusively for residential use, and (b) the sale of petroleum products to        Telephone exchange companies for each telephone voice grade 
governmental  entities and exempt organizations are exempt.  This                  access service line provided as part of that telephone exchange 
exemption does not extend  to  home  heating oil and propane  gas for              service. 
commercial use.                                                                  The law became effective July  1, 2004 for mobile 
 Monthly remittances (PPT-41) and quarterly reconciliation returns           telecommunications and August 1, 2004 for PBX Systems. 
(PPT-40) are required to be filed no later than the 25th day of the month        The fee must be reported on return form ERF-100 which is required 
following the end of the month the tax was collected.                        to be filed on or before the 20th day of the month following the close of 
                                                                             the calendar quarter and must be filed by phone.  Payments must be made 
TOBACCO AND NICOTINE PRODUCTS WHOLESALE SALES                                by electronic check, electronic funds transfer, or credit card. 
AND USE TAX (N.J.S.A. 54:40B-1 et seq.)                                          For more information, please visit the Division of Taxation’s website 
 The Tobacco Products Wholesale Sales and Use Tax is imposed on              at: https://www.state.nj.us/treasury/taxation/pdf/911fee.pdf. 
sales of all tobacco and nicotine products (excluding cigarettes as defined   
in N.J.S.A. 54:40A-2) by a  wholesaler or  distributor. Technical            SPORTS AND     ENTERTAINMENT                   FACILITY         TAX –
information on the Tobacco and Nicotine Products Tax notice is available     MILLVILLE (N.J.S.A. 34:1B-193 et seq.) 
on the Division of Taxation’s website at:                                        Signed into law on January  26, 2007, known  as the “Sports and 
https://www.state.nj.us/treasury/taxation/tobacco.shtml.                     Entertainment  District Urban Revitalization Act”  the  legislation 
                                                                             authorizes a governing body  of an  eligible municipality  to establish  a 
 Distributors and wholesalers who also sell tobacco and nicotine             sports and  entertainment district within  that municipality.   By city 
products at retail or otherwise use the tobacco and nicotine products must   ordinance, approval was granted for the development of the New Jersey 
pay a compensating use tax on the wholesale sales price of the products.     Motorsports Park (“Motorsports Park”) located in Millville.   The act 
 Monthly returns (TP-20) are required to be filed no later than the          authorizes the establishment of one or more new local taxes and dedicates 
20th day of the month following the month the tax was collected.             the revenue from some or all of those taxes to financing projects in the 
                                                                             sports and entertainment district.  A 2% local tax has been imposed in the 
DOMESTIC SECURITY FEE (N.J.S.A. App. A:9-78)                                 Millville Sports and  Entertainment District on receipts from sales 
 The Domestic Security Fee Act imposes a $5 per day fee on motor             (including rentals) of  tangible  personal property, prepared food and 
vehicle rental companies for each day or part thereof that a motor vehicle   beverages, hotel or motel room  occupancies and other transient 
is rented for the transportation of persons and non-commercial freight, for  accommodation rentals (e.g., vacation rentals, houses, rooms, or similar 
a period of not more than 28 days.  The fee, which must be designated as     lodging used on a transient basis) and certain admission charges. 
the "Domestic Security Fee" in the rental agreement, is separate from and        For more information, please see  Technical Bulletin 61  at: 
in addition to any sales tax imposed on the rental transaction and is not to https://www.nj.gov/treasury/taxation/pdf/pubs/tb/tb61.pdf. 
  
                                                                         ‐ ‐ 5
 

(10-2018) 
 
BUSINESS REGISTRATION FORM (NJ-REG) INSTRUCTIONS 
 
The Division of Revenue and Enterprise Services (DORES) adopted this registration procedure to assist you in becoming aware of and understanding 
all of the taxes and related liabilities to which a new business or applicant for a license may be subject.  The procedure covers tax/employer registration 
for ALL types of businesses, and also covers the filing of NEW legal business entities such as domestic/foreign corporations or limited liability 
companies (Public Records Filing, pages 23-24). 
 
All businesses  must complete the registration application (NJ-REG, pages 17-19) in order to  receive the forms, returns, instructions, and other 
information needed to comply with New Jersey laws.  This applies to every individual, corporation, or other legal business entity, or unincorporated 
entity engaged in the conduct or practice of any trade, business, profession, or occupation, whether full time or part time, within the State of New 
Jersey.  Registration requirements also apply to name holder and dormant corporations, as well as to owners of tangible personal property used in a 
business located in New Jersey or leased to another business entity in New Jersey.  Nonprofit "501(c)(3)" or veterans' organizations that need sales 
tax exemption should complete an REG-1E application; see item “A" below for details.  Persons commencing business or opening additional 
places of business must register at least 15 business days prior to commencement or opening.  There is no fee for filing NJ-REG; however, as outlined 
in the instructions, there are fees for filing new business entities. 

                      Mail the completed     NJ-REG to:                                        Overnight Delivery      of NJ-REG to: 
       NJ  DIVISION OF REVENUE & ENTERPRISE SERVICES                                  NJ  DIVISION OF REVENUE & ENTERPRISE SERVICES 
                         CLIENT REGISTRATION                                                          CLIENT REGISTRATION 
                                 PO BOX 252                                                       33 WEST STATE ST 3 rdFLOOR 
                   TRENTON, NEW JERSEY 08646-0252                                                 TRENTON, NEW JERSEY 08608 
 
To submit a Public Records Filing or combined Public Records Filing with         NJ-REG, refer to page 21 (Items 2 a-c). 
 
IMPORTANT – READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE COMPLETING ANY FORMS.  PRINT OR TYPE ALL 
INFORMATION.  PROVIDE A COMPLETE APPLICATION.  FAILURE TO PROPERLY COMPLETE THE APPLICATION MAY DELAY ISSUANCE 
OF YOUR CERTIFICATE OF AUTHORITY OR LICENSE. 
 
PAGE 17 INSTRUCTIONS                                                             L.    If this business will be open all year, check NO.  If this is a seasonal 
A. Check the appropriate box to indicate reason for filing the application.            business, check the “YES” box and circle the months the business will 
   Non-Profits that are 501(c)(3), volunteer fire, veterans’ or PTO                    be OPEN. 
   organizations and need sales tax exemption, file Form REG-1E.  The            M. If the business is a corporation, enter the date and state of incorporation, 
   REG-1E (including Q & A’s) is available through the Forms Request                   the fiscal month of the corporation and the  NJ corporation business 
   System at 800-323-4400 or 609-826-4400 (choose option 4, then 9); or                number of the corporation.  If this business is a subsidiary of another 
   at:                                                                                 corporation, check “YES” and enter the name and FEIN of the parent. 
    https://www.state.nj.us/treasury/taxation/pdf/other_forms/sales/reg1e.pdf.   
B. Enter the FEIN assigned to the employer or business by the Internal           N.    Enter the four-digit Standard Industrial Code (SIC) if known. 
   Revenue Service or if not required, enter the Social Security Number          O.    Enter the six-digit North  American Industrial Classification System 
   assigned to the sole proprietor.  Check the box if you have applied for             Code  (NAICS) if known from Table C, page 14-15. 
   your FEIN.                                                                    P.    Enter the names of the owner, partners or responsible corporate 
C. Enter the corporate name of the business being registered or the name(s)            officer(s).  Enter the social security number, title, and home address for 
   of the owner(s) if a sole proprietor or partnership.                                each person listed. 
                                                                                       
D. Enter  the Trade Name, if different from Item C.                              PAGE 18 INSTRUCTIONS 
E. Enter the address of the physical location of the business, do not use a      Question 1: 
                                                                                 a.    Have you  or  will you be paying  wages, salaries  or commissions  to 
   PO Box   address.  Be sure to include the nine-digit zip code.                      employees working in New Jersey within the next 6 months.  If yes check 
F. Enter the name and address to which all New Jersey tax returns will be              “YES” and enter the date of the first payment.    This date must  be 
   mailed.  Be sure to include the nine-digit zip code.  If you wish to have           provided for Unemployment and Disability registration purposes.  If no 
   different type tax returns go to different addresses, please attach a               check “NO” please be aware that if you begin paying wages you are 
   separate sheet and indicate the address to which each tax return is to go.          required to notify the DORES’ Customer Service Center at 609-292-
G. Enter the date which you started or assumed ownership of this business              9292. 
   in New Jersey.  If your business has not yet started, enter the date that     b.    If 1(a) is “YES” enter the date you hired your 1st New Jersey employee. 
   you  will commence doing  business.  If you are renting out transient 
   accommodations, the earliest date you may use is October 1, 2018.  If no      c.    This date must be provided for Unemployment and  Disability 
   business is conducted in NJ, but, you are going to withhold NJ Gross                registration purposes.  Accumulate the gross periodic payrolls until they 
   Income Tax for employees, enter the date withholding will begin.  Use               add up to a total of $1,000.  Enter that date on line 1c. 
   today’s date if you only need a Business Registration Certificate.            d.    If you will be paying  wages, salaries or commissions to  New Jersey 
H. Check the appropriate box for your Type of Ownership. If you check “S                residents working outside New Jersey, check “YES”. 
   Corporation” complete the New  Jersey S  Corporation Election form            e.    If you  will be the payer of  pensions and/or annuities to New Jersey 
   (CBT-2553)   found in this booklet on pages 40-41.                                  residents, check “YES” and enter the date of the first payment. 
I. Enter your New Jersey Business Code from Table A, pages 9-11.  If you         f.    If you will be holding legalized games of chance in New Jersey (as 
   are engaged in more than one type of business, enter the code for the               defined in Chapter 47 “Rules of Legalized Games of Chance”) where 
   predominant one.  This section must be completed to avoid delays in                 proceeds from any one prize exceed $1,000, check “YES” and enter the 
   issuance of the Certificate of Authority or License.                                date of the first prize awarded (NJ Lottery proceeds are not included). 
J. Enter your New Jersey County/Municipality Code from Table B, pages            g.    A PEO (Employee Leasing  Company) that registers with DORES is 
   12-13.   This code reflects the County/Municipality in which your                   subject to an additional and separate registration process with the NJ 
   business is located.                                                                Department of Labor and  Workforce Development.   To obtain the 
                                                                                       special PEO registration forms and information, please visit the  
K. Enter  the county where your business is located.                                         
                                                                                 ‐ ‐ 6
 

     Department of Labor and Workforce Development’s website at                    employs agricultural workers) is generally subject to FUTA if it had covered 
     https://www.nj.gov/labor/forms_pdfs/ea/PEO-1%20(R-07-12).pdf                  employment during some portion  of a day in 20 different calendar weeks 
     or call 609-633-6400 x 2209.                                                  within the calendar year or had a quarterly payroll of $1,500 or more. 
                                                                                    
Question 2:                                                                        Question 8: 
If you purchased or otherwise came into possession of 90% or more of the           If you believe that you or your business is not required to pay unemployment 
assets of another business, check “Substantially all the assets”.   If you         and temporary disability contributions on wages paid to its employees, check 
purchased or otherwise received the right to continue to operate the entire        “YES” otherwise check “NO”.  Examples are: This is a church or the only 
trade or business of another employer, check “Trade or Business”. If you took      employees of this proprietorship are the spouse and children under age 18. 
over all the employees of an existing business, excluding corporate officers if    You may be subject to New Jersey Gross Income Tax Withholding. 
any, check “Employees”.                                                             
Enter the name, any trade name and address of the business you acquired.           Question 9: 
Also enter the New Jersey Unemployment Registration Number or FEIN of              For principal product or service in New Jersey only, please  provide  a 
the prior business as well as the  date you purchased the business.    Also        description for that product or service which accounts for over 50% of your 
indicate the percentage of assets, trade or business and employees that you        business (e.g. fuel oil).  Please briefly describe the type of activity your 
took over from the prior business.                                                 business is engaged in (e.g. drive a fuel truck to sell fuel oil to consumers). 
                                                                                    
Question 3:                                                                        Question 10: 
When the successor acquires or absorbs and continues the business of a subject     This information is to be supplied by every employer regardless of the number 
predecessor, the successor employer must receive the transfer of the               of work locations in New Jersey or the number of classes of industry which it 
predecessor’s employment experience.   The transfer of employment                  is engaged in.  Please do not describe work location by post office box number.  
experience is required by law.                                                     The incorporated municipalities in which workers operate or to which they 
                                                                                   report daily should be named instead.  If there is more than one location please 
Question 4:                                                                        list each location beginning with the largest employing facility first.  Please 
Agricultural labor means the following activities:                                 provide the location address and indicate the nature of business conducted at 
1.   Services performed on a farm in connection with cultivation of the soil;      each location.  If two or more principal classes of activity are conducted at 
     raising or harvesting any agricultural or horticultural product; raising,     one  location, please indicate. 
     feeding, caring for and managing livestock, bees, poultry or furbearing       In describing the “Nature of Business” classify your “Primary Activity” under 
     animals; handling,  packaging,  or processing any agricultural or             one of the following: wholesale trade, retail trade, manufacturing, mining and 
     horticultural commodity in its unmanufactured state; repair  and              quarrying, construction (general or specific), real estate, insurance, finance, 
     maintenance of  equipment or real property used in the agricultural           transportation, communication, or other public utilities, personal  service, 
     activity; and transport of agricultural or horticultural supplies or products business service, professional service, agriculture, forestry, fishery.   If the 
      if not in the usual course of a trucking business;                           employing unit is engaged in trade, state under “Primary Activity” whether as 
2.   Service performed in a greenhouse or nursery if over 50 percent of the        wholesaler, commission merchant or  wholesale branch of manufacturing 
     gross sales volume is attributable to products raised in the greenhouse or    concern, retailer (store, route, restaurant, fast food, service station, and the 
                                                                                   like), or retail branch of manufacturing concern.  Please refer to the list of 
      nursery; and                                                                  business codes provided. 
3.   Service performed by a cooperative of which the producer of the 
     agricultural product is a member if the service performed is incidental       For units engaged in manufacturing, state the product which has the greatest 
     and necessary to the delivery of the product to market in a finished state.   gross annual value.  Describe also the basic raw materials or articles.  For units 
                                                                                   with more than one principal product or service, show percentage of gross 
Agricultural labor does not include:                                               value in each. 
1.    Service performed at a race track;                                           For contractors (subcontractors) in construction, state the type of activity, such 
2.   Service in the breeding, caring or boarding of domesticated animals of a      as general (building or other), highway, heavy marine (not ship), water well, 
                                                                                   demolition, or specific (i.e. plumbing, painting, masonry or stone, carpentry, 
     kind normally found in a home, such as dogs and cats;                         roofing, concrete, general maintenance construction, etc.), speculative builder, 
3.   Service in a retail enterprise selling the product of an agricultural          development builder. 
     enterprise if the retail enterprise is not located on or contiguous to the 
                                                                                   For service providers, state whether hotel, laundry, photography, barber or 
     site of production; or                                                        beauty, funeral, garment, hygienic, business janitor, news, radio, accounting, 
4.   Service in a retail enterprise located on or contiguous to the site  of       educational, repair, entertainment, amusement, athletic specific professional, 
     production if greater than 50% of the gross sales volume of the retail        etc. 
     enterprise is attributable to items not produced at the site.                 For the wholesaler or retailer, describe primary commodity. 
                                                                                   If engaged in marine transportation, state  whether on inland  waterways, 
Question 5:                                                                         harbors, coastwise or trans-oceanic. 
Household service means service of a personal nature performed outside of a 
business enterprise for a householder.   Household service is  normally            For employers engaged in more than one business activity (i.e. service station, 
performed in a private residence, but may be performed in other settings such      mini-mart) show (in the percent  column) the relative gross business each 
as a nursing home or a yacht.  Household service would include, but is not          activity does. 
limited to, the following occupations:  maids, butlers, cooks, valets, gardeners,  The average number of employees on the payroll at each location and in each 
chauffeurs; personal secretaries, babysitters and nurses’ aides.                   class of activity should be shown.   Please continue on a separate sheet if 
      If “YES” this date is to be provided for Unemployment and Disability         needed. 
      registration purposes.  Accumulate the gross periodic cash payrolls           
      until they add up to a total of $1,000 in a calendar quarter.  Enter that    PAGE 19 INSTRUCTIONS 
      date here.                                                                   Question 11 
                                                                                    a.     If you will be collecting New Jersey Sales Tax and/or paying Use Tax 
Question 6:                                                                                check   “YES” and enter the date of the first sale. 
Has the Internal Revenue Service determined that your organization is exempt        b.     Check “YES” if you will be making tax exempt purchases.  If “YES” 
from income tax as a 501(c)(3) organization?  If yes, check “YES”.                         you  will be issued New Jersey  Resale Certificates (ST-3) and/or 
                                                                                           Exempt Use Certificates (ST-4). 
Question 7:                                                                         
Any employing unit subject to the provisions of the Federal Unemployment           Note: Form ST-3, Resale Certificate.  Given to a seller by a purchaser who is 
Tax  Act (FUTA) in the current  or preceding calendar year  automatically           not the “end user” of the merchandise or services being purchased. 
becomes an employer unless services are specifically excluded under the New 
Jersey Unemployment Law.   An employing unit (other than one which 

                                                                               ‐ ‐ 7
 

Form ST-4, Exempt Use Certificate.  Given to a seller by a purchaser who is              Fuel License Application (MFA-1) along with this form.  You can also 
purchasing merchandise for an exempt use.                                                obtain the MFA-1 at the Division of Taxation’s web site 
 c. If your business is located within Atlantic City, Salem County, North                https://www.state.nj.us/treasury/taxation/pdf/other_forms/motorfuel/
                                                                                         mfa1.pdf. 
    Wildwood,   Wildwood Crest or Wildwood, check the applicable box.                b.  If your company is engaged in refining and/or distributing petroleum 
 d. All NJ locations collecting NJ sales tax must be registered.  If “YES”               products for distribution in this State, or importing petroleum products 
    attach a rider requesting consolidated reporting.                                    into New Jersey for consumption in New Jersey, check “YES.”  If you 
 e. If you sell, store, deliver or transport natural gas or electricity to users         have checked “YES” complete Form REG-L and return it with your 
    or customers whether by mains, lines,  or  pipes located  within this                competed NJ-REG 
    State or by any other means of delivery, check “YES”.                            c.  If you checked “YES” you  will be sent a Direct  Payment Permit 
                                                                                         application. 
Question 12:                                                                         
If you intend to sell cigarettes in New Jersey, check “YES”.  If “YES”              Question 18: 
complete Form CM-100 if you are applying for a retailer or vending machine          If you will be providing merchandise or services to casino licensees or acting 
license.  You will be sent the appropriate license/license application after these  as a contractor or subcontractor to the State or its agencies, check the “YES” 
forms are processed.                                                                box. 
                                                                                     
Question 13:                                                                        Question 19: 
 a. If you are engaged in the business of selling tobacco products in this          Businesses involved in the rental of motor vehicles (less than 28 day 
    State, if you import tobacco products into this State for sale within this      agreements), including passenger autos, trucks and trailers designed for use 
    State, if you make or manufacture tobacco products within this State            on the highways, other than those used for the transportation of commercial 
    for sale in the State, if you sell tobacco products outside this State and      freight, are subject to the payment of a $5 per day Domestic Security Fee.  If 
    ship or transport those products to a person in this State to be sold to        eligible, a business must check YES. 
    a retail dealer, or you are a person that receives  tobacco products 
    without receiving proof that the tax has been or  will  be paid by              For additional information on the Domestic Security Fee, please  visit the 
    another distributor, then you  are  a  distributor of tobacco products.         Division of Taxation’s at https://www.state.nj.us/treasury/taxation/dsf.shtml. 
                                                                                     
    Please   check “YES.”                                                           Question 20: 
 b. If you purchase tobacco products from any other person  who                     If you are engaged in the rental of rooms in a hotel, motel, bed & breakfast or 
    purchases from the manufacturer and acquires the tobacco products               similar facility or you provide other transient accommodation rentals (e.g., 
    solely for resale to retail dealers or to other persons for the purposes        vacation rental, house, room, or similar lodging used on a transient basis), you 
    of resale only, or you service retail outlets by the maintenance of an          are required to collect a State  Occupancy Fee.   In addition,  a Municipal 
    established place of business for the purchase of tobacco products, you         Occupancy  Tax  of up to 3% must also be collected, if enacted  by the 
     are a wholesaler of tobacco products.  Please check “YES.”                     municipality where the facility is located.  If such a facility, check YES.  You 
    Tobacco products include, but are not limited to cigars, little cigars,         will receive the HM-100 return, which must be filed with payment by the 20th 
    cigarillos, chewing tobacco, pipe tobacco, smoking tobacco and their            of each month.  Additional information on the Fee and a list of municipalities 
    substitutes, dry and moist snuff,  and liquid nicotine, but does not            that have enacted the Tax is available on the Division of Taxation’s website: 
    include cigarette as defined in section 10 of the "Cigarette Tax Act"           https://www.state.nj.us/treasury/taxation/transientbuffer.shtml. 
                                                                                     
    P.L.1948,c.65(C.54:40A-1et  seq.).                                              Question 21: 
    If the distributor or  wholesaler  has not collected  the Tobacco  and          For businesses that operate in the Sports and  Entertainment District in 
    Nicotine Products Wholesale Sales and Use Tax from the retailer or              Millville, NJ  a 2% local tax is imposed on receipts from sales (including 
    consumer, then the retailer or consumer is responsible for remitting            rentals) of tangible personal property, prepared food and beverages, rents for 
    the compensating use tax on the price paid or charged directly to the           hotel or motel room occupancies or other transient accommodation rentals 
    Division of Taxation within 20 days of the date the tax was required            (e.g., vacation rentals, houses, rooms, or similar lodging used on a transient 
    to be paid.                                                                     basis), and certain admission charges. 
                                                                                    Taxpayers subject to the tax must file a quarterly SETMI Return, (Form SM- 
Question 14:                                                                        100) and remit any tax due on or before the 20th day of the month following 
If you are a manufacturer, wholesaler, distributor or retailer of litter generating the end of the calendar quarter.  Additional information on the tax, including 
products, check “YES.” Litter-generating products are:  food, soft drinks and       filing instructions, is available on the Division of Taxation’s website at: 
carbonated  water, beer,  wine,  distilled spirits, glass containers, metal         https://www.state.nj.us/treasury/taxation/sports.shtml. 
containers, plastic or fiber containers, groceries, drugstore sundries, cigarettes   
and tobacco products, motor vehicle tires, newsprint and magazine paper             Question 22: 
stock, paper products and household paper, and cleaning agents and toiletries       If you sell new tires, or sell or lease motor vehicles, you must check “YES”.  
                                                                                    You will receive information regarding the collection of the Motor Vehicle 
Question 15:                                                                        Tire Fee. 
If you are an owner or operator of a sanitary landfill facility in New Jersey,       
check “YES” and indicate the facility number and type as classified by the          Question 23: 
New Jersey  Department of  Environmental Protection.   Registration                 If you are a telephone exchange company or a mobile telecommunications 
instructions for the Solid Waste Services and Landfill Closure and                  carrier which provides voice grade access telephone numbers or service lines 
Contingency taxes will be forwarded.                                                as part of that telephone exchange service, thereby providing access to 9-1-1 
                                                                                    service through the public switched network, you must check “YES”.  You 
Question 16:                                                                        will receive the ERF-100 return which is due on a quarterly basis. 
 a. If you operate a facility that has the total combined capacity to store          
    200,000  gallons or more of petroleum products, check “YES.”                    Question 24: 
 b. If you operate a facility that has the total combined capacity to store         Contact Person: Enter the name, title, telephone number and e-mail address 
                                                                                    of the contact person who will answer questions regarding the registration 
     20,000 gallons of hazardous chemicals, check “YES.”                            application. 
 c. If you store petroleum products or hazardous chemicals at a public               
    storage terminal, check “YES” and enter the name of the terminal.  A            Signature: The application must be signed and dated by the owner if a sole 
    Spill Compensation and Control Tax registration application will be             proprietorship, or in the case of a corporation, by the president, vice-president, 
    forwarded.                                                                      secretary, treasurer, comptroller, or other duly authorized officer.  Unsigned 
                                                                                    applications cannot be processed and will be returned. 
Question 17                                                                           
 a. If your company will be involved with the sale or transport of motor 
    fuels and/or petroleum, check “YES”.  If “YES” complete the Motor 
                                                                             ‐ ‐ 8
 

                                                         TABLE A - NEW JERSEY  BUSINESS                    CODES 
               Enter one of the following four-digit numbers on page 17, Block I to indicate the product group or service of your business 
 MISCELLANEOUS WITHHOLDER CODES                          Code  Description                                       Code Description 
Code Description                                         1201  Motor Vehicles                                    2711  Coin Operated Laundries 
2781  Pension Plan Withholders                           1207  Motorboats                                        2602 Computer Hardware, Software, Internet 
7279  Employer of Domestic Household Employees           1209  Motorcycles, Minibikes                            2754  Consulting Services (All Types) 
     MANUFACTURING BUSINESS CODES                        1215  Mufflers                                          2107  Custom Clothing & Tailoring 
1631  Aircraft and Related Supplies                      1606  Musical Instruments & Related Merchandise         2761  Data Processing 
1314 Alcoholic Beverages/Liquor                          1318  Non-Alcoholic Beverages                           2709  Dry Cleaning 
1100 Apparel                                             1402  Office Furniture and Furnishings                  2708  Duplicating, Photocopying 
1404  Appliances, Housewares, Linens                     1616  Optical Goods                                     2903  Electric 
1622  Art, Mechanical Drawing & Related Supplies         1803  Paint, Wallpaper and Decorating                   2905  Electric and Gas 
1815 Asphalt                                             1633  Paintings, Sculpture and Related Artwork          2630 Electronic Equipment
1405  Audio/Visual (TV, Stereo, Records, CD)             1628  Paper and Packaging Products                      2779  Employer of Domestic/Household Employees 
1208  Auto Parts and Related Products/Accessories        1635  Perfumes and Cosmetics                            2745  Employment Agencies 
1220 Auto Windows/Glass                                  1640  Pet Supplies                                      2715  Entertainment (Amusement, Circus, Movies, 
1200 Automotive                                          1313  Pizza                                                  Sports) 
1306 Baked Goods                                         1802  Plumbing Materials                                2718  Equipment Rental/Leasing 
1637  Bicycles and Related Merchandise                   1623  Pools and Related Accessories                     2607  Farm & Garden Equipment & Supplies 
1604  Books, Magazines, Periodicals, Newspapers          1202  Recreational Vehicles, Campers                    2300  Food 
1316 Bottled Water                                       1807  Roofing Materials                                 2106  Footwear 
1809  Building Materials and Supplies                    1822  Siding (Aluminum, Brickface, Stucco)              2737  Funeral Services 
1800 Building/Construction                               1620  Signs and Advertising Displays                    2400  Furniture 
1213  Buses, Bus Parts                                   1636  Soaps, Detergents, etc.                           2904  Gas 
1614  Cameras, Photo Equipment and Supplies              1307  Specialty Foods                                   2204  Gasoline Service Station 
1304  Candy, Nuts and Confectionery                      1605  Sporting Goods and Related Merchandise            2736  Governmental Services 
1104  Children’s & Infants’ Clothing and/or Accessories  1603  Stamps, Coins, Gold, Precious Metals, etc.        2749  Graphics 
1602 Computer Hardware, Software                         1613  Stationery, Greeting Cards, School Supplies       2762  Hair Salons, Hair Dressers, Barber Shops 
1808 Concrete                                            1906  Steam                                             2752  Health Clubs/Programs (Exercise, Tanning, 
1627 Containers (Industrial/Commercial)                  1902  Telegraph                                              Diet) 
1110 Costumes                                            1901  Telephone                                         2759  Hospitals, Clinics, Institutions 
1107  Custom Clothing and Tailoring                      1624  Telephones, Telecommunications Equipment          2701  Hotels & Motels 
1305 Dairy Products                                      1625  Textiles and Related Products                     2768  Import/Export 
1601  Drugs & Medical Supplies, Medical Equipment        1629  Tile and Ceramic Merchandise                      2618  Industrial Tools & Equipment, Machinery 
1502 Dry Goods                                           1203  Tires                                             2755  Instructions (Dancing, Driving, etc.) 
1903 Electric                                            1612  Tobacco Products                                  2732  Insurance 
1905  Electric and Gas                                   1632  Toys and Games                                    2729  Interior Cleaning/Janitorial, Rug Cleaning 
1804 Electrical Materials                                1210  Trailers                                          2756 Interior Decorator
1630 Electronic Equipment                                1214  Transmissions                                     2742  Investment/Financial Services (Pension Plans) 
1812 Energy Conservation Related                         1212  Trucks, Truck Parts                               2608  Jewelry 
1105 Family Clothing                                     1109  Uniforms                                          2725 Junk Dealers
1607  Farm and Garden Equipment and Supplies             1900  Utilities                                         2721 Landscaping, Lawn Service, Gardening 
1823 Fencing                                             1907  Water                                             2617  Leather Goods and Luggage 
1611  Flowers and Related Merchandise                    1816  Well Drilling, Water Pumps                        2726  Linen Service & Rentals 
1300 Food                                                1811  Windows, Doors, Glass                             2771 Locksmith
1106 Footwear                                            1102  Women’s & Girls’ Clothing and/or Accessories      2728  Marinas, Boat & Dock Rentals, Bait 
1103  Formal Wear (Tuxedos, Bridal Gowns, etc.)                                                                  2730  Marine Maintenance & Repairs 
1303  Fruit and/or Vegetables                              SERVICE BUSINESS CODES                                2601 Medical Equipment
1609  Fuel (Bottled Gas, Kerosene, Charcoal, etc.)       2740  Accounting                                        2600 Miscellaneous Products
1400 Furniture                                           2720  Advertising, Public Relations                     2700  Miscellaneous Service 
1108 Furriers                                            2631  Aircraft and Related Supplies                     2753 Modeling Agencies
1904 Gas                                                 2778  Alcoholic Beverage Pick-up & Transport            2621  Models & Hobby Related merchandise 
1500 General Merchandise                                 2775  Apartments, Condominiums, Homeowner               2638  Monuments, Caskets & Related Merchandise 
1615 Gifts, Souvenirs                                     Association                                            2201  Motor Vehicle Dealers (New and/or Used 
1301 Grocery Items                                       2100  Apparel                                                Autos) 
1634  Hair Grooming Supplies                             2404  Appliances, Housewares                            2207  Motorboats 
1813 Hardware                                            2769  Appraising                                        2209 Motorcycles, Minibikes
1315  Health Food Products                               2741  Architecture & Engineering Services               2215  Mufflers 
1810  Heating, Ventilation and Air Conditioning          2717  Athletic Club (Spas, Gyms, etc.)                  2606  Musical Instruments & Related Merchandise 
1401  Household Furniture and Furnishings                2405  Audio/Visual (TV, Stereo, Records, CD)            2719  Nursery, Day Care, Camps 
1610 Ice                                                 2217  Auto Body, Painting                               2747  Nursing Homes & Convalescent Centers 
1311  Ice Cream Products                                 2219  Auto Salvage/Junk Yard                            2616 Optical Goods
1619 Industrial Supplies                                 2218  Auto Upholstery, Vinyl                            2731  Organizations (Scouts, Fraternal, etc.) 
1618  Industrial Tools and Equipment, Machinery          2220  Auto Windows/Glass                                2758  Parking/Parking Lots 
1820  Iron and Steel                                     2205  Automobiles                                       2757  Participating Sports (Golf, Bowling, etc.) 
1608 Jewelry                                             2200  Automotive                                        2727 Pawn Brokers
1406  Lamps, Lights, Shades                              2705  Banks                                             2710 Pest Control
1617  Leather Goods and Luggage                          2637  Bicycles & Related Merchandise                    2723  Pet Grooming, Boarding, Training, Breeding 
1814 Lumber                                              2213  Buses                                             2707  Photo Printing & Processing 
1302  Meat and /or Fish                                  2751  Cable TV                                          2706  Photographic, Sound Studios 
1101  Men’s and Boys’ Clothing and/or Accessories        2614  Cameras, Photo Equipment & Supplies               2623  Pools & Related Accessories 
1111  Millinery and Accessories                          2216  Car Wash & Wax                                    2714  Printing and Publishing 
1626  Miscellaneous Decorative & Display Materials       2767  Casino/Casino Hotel                               2739  Professional Legal Services 
1600 Miscellaneous Products                              2317  Catering                                          2738 Professional Medical Services, Health Care 
1621  Models and Hobby Related Merchandise               2764  Cemeteries, Crematories                           2704  Public Warehousing/Storage 
1638  Monuments, Caskets & Related Merchandise           2744  Charter Fishing                                   2712  Radio and TV Repair 
                                                                                                                    
                                                                                   ‐ ‐ 9
 

                                                   TABLE A - NEW JERSEY  BUSINESS                   CODES (continued) 
               Enter one of the following four-digit numbers on page 17, Block I to indicate the product group or service of your business 
Code Description                                            Code  Description                                  Code   Description
2733 Real Estate                                            3607  Farm & Garden Equipment & Supplies           3109  Uniforms 
2202  Recreational Vehicles, Campers                        3823  Fencing                                      3900   Utilities
2776 Recycling Related                                      3611  Flowers & Related Merchandise                3907  Water 
2401  Refinishing, Upholstery, etc.                         3300  Food                                         3816  Well Drilling, Water Pumps 
2702  Rooming & Boarding Houses                             3106  Footwear                                     3811   Windows, Doors, Glass 
2748  Safe Deposit Boxes (Post Office, Bank)                3103  Formal Wear (Tuxedos, Bridal Gowns, etc.)    3102  Women’s & Girls’ Clothing and/or Accessories 
2750  Security Services, Alarms                             3303  Fruit and/or Vegetables                              
2773  Shipping & Mailing, Couriers                          3609  Fuel (Bottled Gas, Kerosene, Charcoal, etc.)         CONSTRUCTION BUSINESS CODES 
2620  Signs & Advertising Displays                          3400  Furniture                                    4815   Asphalt
2765 Snow Removal                                           3108  Furriers                                     4800   Building
2716  Social Club (Dating, etc.)                            3904  Gas                                          4806  Carpentering & Wood Flooring 
2605  Sporting Goods & Related Merchandise                  3500  General Merchandise                          4808  Concrete Work 
2906 Steam                                                  3615  Gifts, Souvenirs                             4817  Demolition, Excavation 
2770 Surveying                                              3301  Grocery Items                                4821  Dry Wall, Plaster 
2902 Telegraph                                              3634  Hair Grooming Supplies                       4804  Electrical Work 
2901 Telephone                                              3813  Hardware                                     4812   Energy Conservation
2624  Telephones, Telecommunications Equipment              3315  Health Food Products                         4823  Fencing 
2203 Tires                                                  3810  Heating, Ventilation & Air Conditioning      4801  General Building Contractor 
2211 Towing                                                 3401  Household Furniture & Furnishings            4810  Heating & Air Conditioning 
2632  Toys & Games                                          3610  Ice                                          4820  Iron & Steel 
2703  Trailer Parks & Camps                                 3311  Ice Cream Products                           4805  Masonry & Stonework 
2210 Trailers                                               3619  Industrial Supplies                          4818  Miscellaneous Construction & Repair 
2214 Transmissions                                          3618  Industrial Tools & Equipment, Machinery      4803  Painting, Paper Hanging & Decorating 
2734 Transportation (Limousines, Chauffeurs, Taxis, Buses)  3820  Iron & Steel                                 4802  Plumbing 
2724 Trash Removal                                          3608  Jewelry                                      4807   Roofing
2722 Travel Agencies                                        3406  Lamps, Lights, Shades                        4819  Septic & Cesspool 
2743  Trucking and Moving                                   3617  Leather Goods & Luggage                      4822  Siding (Aluminum, Brickface, Stucco) 
2212 Trucks                                                 3814  Lumber                                       4816   Well Drilling
2763 Unions                                                 3302  Meat and/or Fish                             4811  Windows, Doors, Glass 
2713  Upholstery & Furniture Repair, Refinishing            3101  Men’s & Boys’ Clothing and/or Accessories            
2900 Utilities                                              3111  Millinery & Accessories                              RETAIL BUSINESS CODES 
2774 Valet                                                  3626  Miscellaneous Decorative & Display Materials 5631  Aircraft & Related Supplies 
2760  Veterinarians, Animal Hospitals                       3600  Miscellaneous Products                       5314  Alcoholic Beverages/Liquor 
2772  Video Rentals & Related                               3621  Models & Hobby Related Merchandise           5508  Annual Shows 
2907 Water                                                  3638  Monuments, Caskets & Related Merchandise     5100  Apparel 
2777  Water Systems Related (Purification, Pumps, etc.)     3201  Motor Vehicles                               5404  Appliances, Housewares, Linens 
2766 Welding                                                3207  Motorboats                                   5622  Art, Mechanical Drawing & Related Supplies 
2735 Window Washing                                         3209  Motorcycles, Minibikes                       5815  Asphalt 
2746  Word Processing, Typing, Addressing, etc.             3215  Mufflers                                     5405  Audio/Visual (TV, Stereo, Records, CD, etc.) 
       3606  Musical Instruments & Related Merchandise                                                         5208   Auto Parts and Related Products/Accessories 
     WHOLESALE BUSINESS CODES                               3318  Non-Alcoholic Beverages                      5218  Auto Upholstery, Vinyl 
3631  Aircraft & Relates Supplies                           3402  Office Furniture & Furnishings               5220  Auto Windows/Glass 
3314 Alcoholic Beverages/Liquor                             3616  Optical Goods                                5219  Automobile Junk/Scrap Yard 
3100 Apparel                                                3803  Paint, Wallpaper & Decorating                5206  Automobile Rentals and Leasing 
3404  Appliances, Housewares, Linens                        3633  Paintings, Sculpture & Related Artwork       5200   Automotive
3622  Art, Mechanical Drawing & Related Supplies            3628  Paper & Packaging Products                   5306  Bakeries 
3815 Asphalt                                                3635  Perfumes & Cosmetics                         5309  Bars, Taverns, Pubs 
3405  Audio/Visual (TV, Stereo, Records, DC, etc.)          3640  Pet Supplies                                 5637  Bicycles and Related Merchandise 
3208  Auto Parts & Related Products/Accessories             3313  Pizza                                        5604  Books, Magazines, Periodicals, Newspapers 
3220 Auto Windows/Glass                                     3802  Plumbing Materials                           5316  Bottled Water 
3200 Automotive                                             3623  Pools & Related Accessories                  5800  Building 
3306 Baked Goods                                            3202  Recreational Vehicles, Campers               5809  Building Materials and Supplies 
3637  Bicycles & Related Merchandise                        3639  Religious Articles, Clothing & Related       5213  Buses, Bus Parts 
3604  Books, Magazines, Periodicals, Newspapers             3807  Roofing Materials                            5614  Cameras, Photo Equipment and Supplies 
3316 Bottled Water                                          3403  Second Hand Items/Antiques                   5304  Candy, Nuts and Confectionery 
3809  Building Materials & Supplies                         3822  Siding (Aluminum, Brickface, Stucco)         5317  Catering 
3800 Building/Construction                                  3620  Signs & Advertising Displays                 5104  Children’s & Infants’ Clothing and/or Accessories 
3213  Buses, Bus Parts                                      3636  Soaps, Detergents, etc.                      5641  Collectors Items (Baseball Cards, Comics, etc.) 
3614  Cameras, Photo Equipment & Supplies                   3307  Specialty Foods                              5602  Computer Hardware, Software 
3304  Candy, Nuts & Confectionery                           3605  Sporting Goods & Related Merchandise         5808  Concrete 
3104  Children’s & Infants’ Clothing and/or Accessories     3603  Stamps, Coins, Gold, Precious Metals, etc.   5627  Containers (Industrial/Commercial) 
3602 Computer Hardware, Software                            3613  Stationery, Greeting Cards, School Supplies  5110  Costumes 
3808 Concrete                                               3906  Steam                                        5107  Custom Clothing and Tailoring 
3627 Containers (Industrial/Commercial)                     3902  Telegraph                                    5305   Dairy Products
3110 Costumes                                               3901  Telephone                                    5501   Department Store
3305 Dairy Products                                         3624  Telephones, Telecommunications Equipment     5506   Direct Selling Organization (Amway, etc.) 
3601  Drugs & Medical Supplies, Medical Equipment           3625  Textiles & Related Products                  5601  Drugs and Medical Supplies, Medical 
3502 Dry Goods                                              3629  Tile & Ceramic Merchandise                          Equipment 
3903 Electric                                               3203  Tires                                        5502  Dry Goods and General Merchandise 
3905  Electric & Gas                                        3612  Tobacco Products                             5804  Electrical Materials 
3804 Electrical Materials                                   3632  Toys & Games                                 5630  Electronic Equipment 
3630 Electronic Equipment                                   3210  Trailers                                     5812   Energy Conservation Related
3812 Energy Conservation Related                            3214  Transmissions                                5105   Family Clothing
3105 Family Clothing                                        3212  Trucks, Truck Parts                          5607  Farm and Garden Equipment and Supplies 

                                                                                    ‐10‐ 
  

                                                   TABLE A - NEW JERSEY  BUSINESS              CODES (continued) 
               Enter one of the following four-digit numbers on page 17, Block I to indicate the product group or service of your business 
Code Description                                           Code  Description                                    Code Description
5312  Fast Food (Burgers, Chicken, Hot Dogs, Tacos, etc.)  5504  Limited Price Variety Store                    5202  Recreational Vehicles, Campers 
5823 Fencing                                               5814  Lumber                                         5639  Religious Articles, Clothing and Related 
5507 Flea Markets                                          5503  Mail Order House                               5310  Restaurants (With Liquor) 
5611  Flowers and Related Merchandise                      5302  Meat and Fish                                  5308  Restaurants, Diners, Eateries (No Liquor) 
5300 Food                                                  5101  Men’s and Boy’s Clothing and/or Accessories    5807  Roofing Materials 
5106 Footwear                                              5505  Merchandise Vending Machine Operator           5403  Second Hand Items/Antiques 
5103  Formal Wear (Tuxedos, Bridal Gowns)                  5111  Millinery and Accessories                      5822  Siding 
5303  Fruit and Vegetables, Produce Stands                 5626  Miscellaneous Decorative & Display Materials   5620  Signs and Advertising Displays 
5609  Fuel (Bottled Gas, Kerosene, Charcoal, etc.)         5600  Miscellaneous Products                         5636  Soaps, Detergents, etc. 
5400 Furniture                                             5621  Models and Hobby Related Merchandise           5307  Specialty Foods (Charles Chips) 
5108 Furriers                                              5638  Monuments, Caskets & Related Merchandise       5605  Sporting Goods and Related Merchandise 
5500 General Merchandise                                   5201  Motor Vehicle Dealers (New and /or Used Autos) 5603  Stamps, Coins, Gold, Precious Metals, etc. 
5615 Gifts, Souvenirs                                      5207  Motorboats                                     5613  Stationery, Greeting Cards, School Supplies 
5301 Groceries Including Delicatessens                     5209  Motorcycles, Minibikes                         5624  Telephones, Telecommunications Equipment 
5634  Hair Grooming Supplies                               5215  Mufflers                                       5625  Textiles and Related Products 
5813 Hardware                                              5606  Musical Instruments and Related Merchandise    5629  Tile and Ceramic Merchandise 
5315 Health Foods                                          5318  Non-Alcoholic Beverages                        5203  Tires 
5810  Heating, Ventilation & Air Conditioning              5402  Office Furniture, Equipment and Supplies       5612  Tobacco Products 
5401  Household Furniture & Furnishings                    5616  Optical Goods                                  5632  Toys and Games 
5610 Ice                                                   5803  Paint, Wallpaper                               5210 Trailers
5311  Ice Cream Products                                   5633  Paintings, Sculpture and Related Artwork       5214 Transmissions
5619 Industrial Supplies                                   5628  Paper and Packaging Products                   5212  Trucks, Truck Parts 
5618  Industrial Tools and Equipment, Machinery            5635  Perfumes and Cosmetics                         5109  Uniforms 
5820  Iron and Steel                                       5640  Pet Supplies                                   5816  Well Drilling, Water Pumps 
5608 Jewelry                                               5313  Pizzerias                                      5811  Windows, Doors, Glass 
5406  Lamps, Lights, Shades                                5802  Plumbing Materials                             5102  Women’s and Girl’s Clothing and/or Accessories 
5617  Leather Goods and Luggage                            5623  Pools and Related Accessories                        
  
                                                                                  ‐11‐ 
 

                                       TABLE B - NEW JERSEY COUNTY / MUNICIPALITY CODES 
                                   Enter the Appropriate Four Digit Number in the Boxes Provided on Page 17, Item J. 
                                    Location                               Location                                  Location
Location Municipality County           Code  Municipality County             Code   Municipality County               Code   Municipality County 
Code 
         ATLANTIC COUNTY               0258  Saddle River Borough            0427   Pennsauken Township               0813   Newfield Borough
0101     Absecon City                  0259  South Hackensack Township       0428   Pine Hill Borough                 0814   Paulsboro Borough
0102     Atlantic City                 0260  Teaneck Township                0429   Pine Valley Borough               0815   Pitman Borough
0103     Brigantine City               0261  Tenafly Borough                 0430   Runnemede Borough                 0816   South Harrison Township 
0104     Buena Borough                 0262  Teterboro Borough               0431   Somerdale Borough                 0817   Swedesboro Borough
0105     Buena Vista Township          0263  Upper Saddle River Borough      0432   Stratford Borough                 0818   Washington Township
0106     Corbin City                   0264  Waldwick Borough                0433   Tavistock Borough                 0819   Wenonah Borough
0107     Egg Harbor City               0265  Wallington Borough              0434   Voorhees Township                 0820   West Deptford Township 
0108     Egg Harbor Township           0266  Washington Township             0435   Waterford Township                0821   Westville Borough
0109     Estell Manor City             0267  Westwood Borough                0436   Winslow Township                  0822   Woodbury City
0110     Folsom Borough                0268  Woodcliff Lake Borough          0437   Woodlynne Borough                 0823   Woodbury Heights Borough 
0111     Galloway Township             0269  Wood-Ridge Borough                                                       0824   Woolwich Township
0112     Hamilton Township             0270  Wyckoff Township                0501 CAPEAvalonMAYBoroughCOUNTY                 HUDSON COUNTY 
0113     Hammonton Town             
0114     Linwood City                       BURLINGTON COUNTY                0502   Cape May City                     0901   Bayonne City 
0115     Longport Borough              0301  Bass River Township             0503   Cape May Point Borough            0902   East Newark Borough 
0116     Margate City                  0302  Beverly City                    0504   Dennis Township                   0903   Guttenberg Town
0117     Mullica Township              0303  Bordentown City                 0505   Lower Township                    0904   Harrison Town
0118     Northfield City               0304  Bordentown Township             0506   Middle Township                   0905   Hoboken City
0119     Pleasantville City            0305  Burlington City                 0507   North Wildwood City               0906   Jersey City
0120     Port Republic City            0306  Burlington Township             0508   Ocean City                        0907   Kearny Town
0121     Somers Point City             0307  Chesterfield Township           0509   Sea Isle City                     0908   North Bergen Township 
0122     Ventnor City                  0308  Cinnaminson Township            0510   Stone Harbor Borough              0909   Secaucus Town
0123     Weymouth Township             0309  Delanco Township                0511   Upper Township                    0910   Union City
   0310                                      Delran Township                 0512   West Cape May Borough             0911   Weehawken Township
         BERGEN COUNTY                 0311  Eastampton Township             0513   West Wildwood Borough             0912   West New York Township 
0201     Allendale Borough             0312  Edgewater Park Township         0514   Wildwood City               
0202     Alpine Borough                0313  Evesham Township                0515   Wildwood Crest Borough                 HUNTERDON COUNTY 
0203     Bergenfield Borough           0314  Fieldsboro Borough              0516   Woodbine Borough                  1001   Alexandria Township
0204     Bogota Borough                0315  Florence Township                                                        1002   Bethlehem Township
0205     Carlstadt Borough             0316  Hainesport Township                  CUMBERLAND COUNTY                   1003   Bloomsbury Borough
0206     Cliffside Park Borough        0317  Lumberton Township              0601   Bridgeton City                    1004   Califon Borough
0207     Closter Borough               0318  Mansfield Township              0602   Commercial Township               1005   Clinton Town
0208     Cresskill Borough             0319  Maple Shade Township            0603   Deerfield Township                1006   Clinton Township
0209     Demarest Borough              0320  Medford Township                0604   Downe Township                    1007   Delaware Township
0210     Dumont Borough                0321  Medford Lakes Borough           0605   Fairfield Township                1008   East Amwell Township 
0212     East Rutherford Borough       0322  Moorestown Township             0606   Greenwich Township                1009   Flemington Borough
0213     Edgewater Borough             0323  Mount Holly Township            0607   Hopewell Township                 1010   Franklin Township
0211     Elmwood Park Borough          0324  Mount Laurel Township           0608   Lawrence Township                 1011   Frenchtown Borough
0214     Emerson Borough               0325  New Hanover Township            0609   Maurice River Township            1012   Glen Gardner Borough 
0215     Englewood City                0326  North Hanover Township          0610   Millville City                    1013   Hampton Borough
0216     Englewood Cliffs Borough      0327  Palmyra Borough                 0611   Shiloh Borough                    1014   High Bridge Borough 
0217     Fair Lawn Borough             0328  Pemberton Borough               0612   Stow Creek Township               1015   Holland Township
0218     Fairview Borough              0329  Pemberton Township              0613   Upper Deerfield Township          1016   Kingwood Township
0219     Fort Lee Borough              0330  Riverside Township              0614   Vineland City                     1017   Lambertville City
0220     Franklin Lakes Borough        0331  Riverton Borough                                                         1018   Lebanon Borough
0221     Garfield City                 0332  Shamong Township                       ESSEX COUNTY                      1019   Lebanon Township
0222     Glen Rock Borough             0333  Southampton Township            0701   Belleville Township               1020   Milford Borough
0223     Hackensack City               0334  Springfield Township            0702   Bloomfield Township               1021   Raritan Township
0224     Harrington Park Borough       0335  Tabernacle Township             0703   Caldwell Borough                  1022   Readington Township
0225     Hasbrouck Heights Borough     0336  Washington Township             0704   Cedar Grove Township              1023   Stockton Borough
0226     Haworth Borough               0337  Westampton Township             0705   East Orange City                  1024   Tewksbury Township
0227     Hillsdale Borough             0338  Willingboro Township            0706   Essex Fells Township              1025   Union Township
0228     Ho Kus Borough                0339  Woodland Township               0707   Fairfield Township                1026   West Amwell Township 
0229     Leonia Borough                0340  Wrightstown Borough             0708   Glen Ridge Borough                
0230     Little Ferry Borough                                                0709   Irvington Township                       MERCER COUNTY 
0231     Lodi Borough                        CAMDEN COUNTY                   0710   Livingston Township               1101   East Windsor Township 
0232     Lyndhurst Township            0401  Audubon Borough                 0711   Maplewood Township                1102   Ewing Township
0233     Mahwah Township               0402  Audubon Park Borough            0712   Millburn Township                 1103   Hamilton Township
0234     Maywood Borough               0403  Barrington Borough              0713   Montclair Township                1104   Hightstown Borough
0235     Midland Park Borough          0404  Bellmawr Borough                0714   Newark City                       1105   Hopewell Borough
0236     Montvale Borough              0405  Berlin Borough                  0715   North Caldwell Township           1106   Hopewell Township
0237     Moonachie Borough             0406  Berlin Township                 0716   Nutley Township                   1107   Lawrence Township
0238     New Milford Borough           0407  Brooklawn Borough               0717   Orange City                       1108   Pennington Borough
0239     North Arlington Borough       0408  Camden City                     0718   Roseland Borough                  1114   Princeton
0240     Northvale Borough             0409  Cherry Hill Township            0719   South Orange Village Twp.         1112   Robbinsville Township
0241     Norwood Borough               0410  Chesilhurst Borough             0720   Verona Township                   1111   Trenton City
0242     Oakland Borough               0411  Clementon Borough               0721   West Caldwell Township            1113   West Windsor Township 
0243     Old Tappan Borough            0412  Collingswood Borough            0722   West Orange Township              
0244     Oradell Borough               0413  Gibbsboro Borough                                                             MIDDLESEX COUNTY 
0245     Palisades Park Borough        0414  Gloucester City                      GLOUCESTER COUNTY                   1201   Carteret Borough
0246     Paramus Borough               0415  Gloucester Township             0801   Clayton Borough                   1202   Cranbury Township
0247     Park Ridge Borough            0416  Haddon Township                 0802   Deptford Township                 1203   Dunellen Borough
0248     Ramsey Borough                0417  Haddonfield Borough             0803   East Greenwich Township           1204   East Brunswick Township 
0249     Ridgefield Borough            0418  Haddon Heights Borough          0804   Elk Township                      1205   Edison Township
0250     Ridgefield Park Village       0419  Hi-Nella Borough                0805   Franklin Township                 1206   Helmetta Borough
0251     Ridgewood Village             0420  Laurel Springs Borough          0806   Glassboro Borough                 1207   Highland Park Borough 
0252     River Edge Borough            0421  Lawnside Borough                0807   Greenwich Township                1208   Jamesburg Borough
0253     River Vale Township           0422  Lindenwold Borough              0808   Harrison Township                 1209   Metuchen Borough
0254     Rochelle Park Township        0423  Magnolia Borough                0809   Logan Township                    1210   Middlesex Borough
0255     Rockleigh Borough             0424  Merchantville Borough           0810   Mantua Township                   1211   Milltown Borough
0256     Rutherford Borough            0425  Mount Ephraim Borough           0811   Monroe Township                   1212   Monroe Township
      0257 Saddle Brook Township       0426  Oaklyn Borough                  0812   National Park Borough           
                                                                                                                 
                                                                        ‐12‐ 
 

                                          TABLE B - NEW JERSEY COUNTY / MUNICIPALITY CODES 
                                      Enter the Appropriate Four Digit Number in the Boxes Provided on Page 17, Item J. 
Location Municipality County             Location Municipality County           Location Municipality County            Location Municipality County 
 Code                                     Code                                    Code                                  Code 
 1213    New Brunswick City               1416    Lincoln Park Borough            1707   Oldmans Township               2103     Belvidere Town
 1214    North Brunswick Township         1430    Long Hill Township              1708   Penns Grove Borough            2104     Blairstown Township
 1215    Old Bridge Township              1417    Madison Borough                 1709   Pennsville Township            2105     Franklin Township
 1216    Perth Amboy City                 1418    Mendham Borough                 1710   Pilesgrove Township            2106     Frelinghuysen Township
 1217    Piscataway Township              1419    Mendham Township                1711   Pittsgrove Township            2107     Greenwich Township
 1218    Plainsboro Township              1420    Mine Hill Township              1712   Quinton Township               2108     Hackettstown Town
 1219    Sayreville Borough               1421    Montville Township              1713   Salem City                     2109     Hardwick Township
 1220    South Amboy City                 1423    Morris Plains Borough           1714   Upper Pittsgrove Township      2110     Harmony Township
 1221    South Brunswick Township         1422    Morris Township                 1715   Woodstown Borough              2111     Hope Township
 1222    South Plainfield Borough         1424    Morristown Town                                                       2112     Independence Township
 1223    South River Borough              1425    Mountain Lakes Borough               SOMERSET COUNTY                  2113     Knowlton Township
 1224    Spotswood Borough                1426    Mount Arlington Borough         1801   Bedminster Township            2114     Liberty Township
 1225    Woodbridge Township              1427    Mount Olive Township            1802   Bernards Township              2115     Lopatcong Township
                         Netcong Borough  1428                                    1803   Bernardsville Borough          2116     Mansfield Township
      MONMOUTH COUNTY                     1429    Parsippany-Trop Hills Twp.      1804   Bound Brook Borough            2117     Oxford Township.
 1301    Aberdeen Township                1431    Pequannock Township             1805   Branchburg Township            2119     Phillipsburg Town
 1302    Allenhurst Borough               1432    Randolph Township               1806   Bridgewater Township           2120     Pohatcong Township
 1303    Allentown Borough                1433    Riverdale Borough               1807   Far Hills Borough              2121     Washington Borough
 1304    Asbury Park City                 1434    Rockaway Borough                1808   Franklin Township              2122     Washington Township
 1305    Atlantic Highlands Borough       1435    Rockaway Township               1809   Green Brook Township           2123     White Township
 1306    Avon-by-the Sea Borough          1436    Roxbury Township                1810   Hillsborough Township            
 1307    Belmar Borough                   1437    Victory Gardens Borough         1811   Manville Borough               2200     ALABAMA
 1308    Bradley Beach Borough            1438    Washington Township             1812   Millstone Borough              2300     ALASKA
 1309    Brielle Borough                  1439    Wharton Borough                 1813   Montgomery Township            2400     ARIZONA
 1310    Colts Neck Township                                                      1814   North Plainfield Borough       2500     ARKANSAS
 1311    Deal Borough                             OCEAN COUNTY                    1815   Peapack & Gladstone Borough    2600     CALIFORNIA
 1312    Eatontown Borough                1501    Barnegat Township               1816   Raritan Borough                2700     COLORADO
 1313    Englishtown Borough              1502    Barnegat Light Borough          1817   Rocky Hill Borough             2800     CONNECTICUT
 1314    Fair Haven Borough               1503    Bay Head Borough                1818   Somerville Borough             2900     DELAWARE
 1315    Farmingdale Borough              1504    Beach Haven Borough             1819   South Bound Brook Borough      3000     DIS OF COLUMBIA 
 1316    Freehold Borough                 1505    Beachwood Borough               1820   Warren Township                3100     FLORIDA
 1317    Freehold Township                1506    Berkeley Township               1821   Watchung Borough               3200     GEORGIA
 1318    Hazlet Township                  1507    Brick Township                                                        3300     HAWAII
 1319    Highlands Borough                1509    Eagleswood Township                    SUSSEX COUNTY                  3400     IDAHO
 1320    Holmdel Township                 1510    Harvey Cedars Borough           1901   Andover Borough                3500     ILLINOIS
 1321    Howell Township                  1511    Island Heights Borough          1902   Andover Township               3600     INDIANA
 1322    Interlaken Borough               1512    Jackson Township                1903   Branchville Borough            3700     IOWA
 1323    Keansburg Borough                1513    Lacey Township                  1904   Byram Township                 3800     KANSAS
 1324    Keyport Borough                  1514    Lakehurst Borough               1905   Frankford Township             3900     KENTUCKY
 1346    Lake Como Borough                1515    Lakewood Township               1906   Franklin Borough               4000     LOUISANA
 1325    Little Silver Borough            1516    Lavallette Borough              1907   Fredon Township                4100     MAINE
 1326    Loch Arbour Village              1517    Little Egg Harbor Township      1908   Green Township                 4200     MARYLAND
 1327    Long Branch City                 1518    Long Beach Township             1909   Hamburg Borough                4300     MASSACHUSETS
 1328    Manalapan Township               1519    Manchester Township             1910   Hampton Township               4400     MICHIGAN
 1329    Manasquan Borough                1520    Mantoloking Borough             1911   Hardyston Township             4500     MINNESOTA
 1330    Marlboro Township                1522    Ocean Gate Borough              1912   Hopatcong Borough              4600     MISSISSIPPI
 1331    Matawan Borough                  1521    Ocean Township                  1913   Lafayette Township             4700     MISSOURI
 1332    Middletown Township              1523    Pine Beach Borough              1914   Montague Township              4800     MONTANA
 1333    Millstone Township               1524    Plumsted Township               1915   Newton Town                    4900     NEBRASKA
 1334    Monmouth Beach Borough           1525    Point Pleasant Borough          1916   Ogdensburg Borough             5000     NEVADA
 1336    Neptune City Borough             1526    Pt Pleasant Beach Borough       1917   Sandyston Township             5100     NEW HAMPSHIRE
 1335    Neptune Township                 1527    Seaside Heights Borough         1918   Sparta Township                5200     UNKNOWN
 1337    Ocean Township                   1528    Seaside Park Borough            1919   Stanhope Borough               5300     NEW MEXICO
 1338    Oceanport Borough                1529    Ship Bottom Borough             1920   Stillwater Township            5400     NEW YORK
 1339    Red Bank Borough                 1530    South Toms River Borough        1921   Sussex Borough                 5500     NORTH CAROLINA
 1340    Roosevelt Borough                1531    Stafford Township               1922   Vernon Township                5600     NORTH DAKOTA
 1341    Rumson Borough                   1532    Surf City Borough               1923   Walpack Township               5700     OHIO
 1342    Sea Bright Borough               1508    Toms River Township             1924   Wantage Township               5800     OKLAHOMA
 1343    Sea Girt Borough                 1533    Tuckerton Borough                                                     5900     OREGON
 1344    Shrewsbury Borough                                                              UNION COUNTY                   6000     PENNSYLVANIA
 1345    Shrewsbury Township                      PASSAIC COUNTY                  2001   Berkeley Heights Township      6100     RHODE ISLAND
 1347    Spring Lake Borough              1601    Bloomingdale Borough            2002   Clark Township                 6200     SOUTH CAROLINA
 1348    Spring Lake Heights Borough      1602    Clifton City                    2003   Cranford Township              6300     SOUTH DAKOTA
 1349    Tinton Falls Borough             1603    Haledon Borough                 2004   Elizabeth City                 6400     TENNESSEE
 1350    Union Beach Borough              1604    Hawthorne Borough               2005   Fanwood Borough                6500     TEXAS
 1351    Upper Freehold Township          1605    Little Falls Township           2006   Garwood Borough                6600     UTAH
 1352    Wall Township                    1606    North Haledon Borough           2007   Hillside Township              6700     VERMONT
 1353    West Long Branch Borough         1607    Passaic City                    2008   Kenilworth Borough             6800     VIRGINIA
                         Paterson City    1608                                    2009   Linden City                    6900     WASHINGTON
         MORRIS COUNTY                    1609    Pompton Lakes Borough           2010   Mountainside Borough           7000     VIRGINIA
 1401    Boonton Town                     1610    Prospect Park Borough           2011   New Providence Borough         7100     WISCONSIN
 1402    Boonton Township                 1611    Ringwood Borough                2012   Plainfield City                7200     WYOMING
 1403    Butler Borough                   1612    Totowa Borough                  2013   Rahway City                    7300     PUERTO RICO
 1404    Chatham Borough                  1613    Wanaque Borough                 2014   Roselle Borough                7400     NETHERLAND
 1405    Chatham Township                 1614    Wayne Township                  2015   Roselle Park Borough           7500     BELGIUM
 1406    Chester Borough                  1615    West Milford Township           2016   Scotch Plains Township         7600     ARGENTINA
 1407    Chester Township                 1616    Woodland Park Borough           2017   Springfield Township           7700     CANADA
 1408    Denville Township                                                        2018   Summit City                    7800     MEXICO
 1409    Dover Town                               SALEM COUNTY                    2019   Union Township                 7900     VIRGIN ISLANDS
 1410    East Hanover Township            1701    Alloway Township                2020   Westfield Town                 8000     ENGLAND
 1411    Florham Park Borough             1702    Carneys Point Township          2021   Winfield Township              8100     CHINA
 1412    Hanover Township                 1703    Elmer Borough                                                         8200     GERMANY
 1413    Harding Township                 1704    Elsinboro Township                     WARREN COUNTY                  8300     IRELAND
 1414    Jefferson Township               1705    Lower Alloway Creek Twp.        2101   Allamuchy Township             8400     GREECE
 1415    Kinnelon Borough                 1706    Mannington Township             2102   Alpha Borough                  8500     ISRAEL
                                                                                                                        
                                                                             ‐13‐ 
  

                                                                          TABLE C - NAICS         CODES 
                                              Enter the Appropriate Six-Digit Number in the Boxes Provided on Page 17, Item O 
Accommodation, Food Service, &                Museums, Historical Sites, &    Similar        621330  Offices of mental health              325900  Other chemical product & 
Drinking Places:                              Institutions                                   practitioners (except physicians)             preparation mfg. 
                                              712100 Museums, historical sites, & similar    621320  Offices of optometrists                 
Accommodation                                 institutions                                   621340  Offices of physical, occupational &   Food  Manufacturing 
721310  Rooming & boarding houses                                                            speech therapists, & audiologists             311110   Animal food mfg. 
721210  RV (recreational vehicle) parks &     PerformingArts,  Spectator Sports, &           621111  Offices of physicians (except mental  311800  Bakeries & tortilla mfg. 
recreational camps                            Related  Industries                            health specialists)                           311500  Dairy product mfg. 
721100  Travel accommodation (including       711410  Agents & managers for artists,         621112  Offices of physicians, mental health  311400  Fruit & vegetable preserving &  
hotels, motels, & bed & breakfast inns)       athletes, entertainers, & other public figures specialists                                   specialty food mfg. 
                                              711510  Independent artists, writers, &        621391  Offices of podiatrists                311200  Grain & oilseed milling 
Food Services &    Drinking Places            performers                                     621399  Offices of all other miscellaneous    311610  Animal slaughtering & processing 
722410  Drinking places (alcoholic            711100  Performing arts companies              health practitioners                          311710  Seafood product preparation & 
beverages)                                    711300 Promoters of performing arts, sports,   621400  Outpatient care centers               packaging 
722110  Full-service restaurants              & similar events                               621900  Other ambulatory health care          311300  Sugar & confectionery product mfg. 
722210  Limited-service eating places         711210  Spectator sports (including            services (including ambulance services,       311900  Other food mfg. (including coffee, 
722300  Special food services (including food  professional sports clubs & racetrack         blood, & organ banks)                         tea, flavorings, & seasonings) 
service contractors & caterers)               operations)                                                                                   
                                                                                             Hospitals                                     Leather & Allied Product 
Administrative & Support and Waste            Construction                                   622000  Hospitals                             Manufacturing 
Management & Remediation Services:            233110  Land subdivision & land                                                              316210 Footwear mfg. (including leather, 
                                              development                                    Nursing &   Residential Care Facilities       rubber, & plastics) 
Administrative & Support Services             233300  Nonresidential building construction   623000  Nursing & residential care facilities 316110  Leather & hide tanning & finishing 
561430  Business service centers              233200  Residential building construction                                                    316990  Other leather & allied product mfg. 
561740  Carpet & upholstery cleaning                                                         Social Assistance                               
services                                      Heavy  Construction                            624410  Child day care services               Nonmetallic Mineral    Product 
561440  Collection agencies                   234100  Highway, street, bridge, & tunnel      624200  Community food & housing, &           Manufacturing 
561450  Credit bureaus                        construction                                   emergency & other relief services             327300  Cement & concrete product mfg. 
561410  Document preparation services         234900  Other heavy construction               624100  Individual & family services          327100  Clay product & refractory mfg. 
561300  Employment services                                                                  624310  Vocational rehabilitation services    327210  Glass & glass product mfg. 
561710 Exterminating & pest control services  Special Trade   Contractors                                                                  327400  Lime & gypsum product mfg. 
561210  Facilities support (management)       235500 Carpentry & floor contractors           Information                                   327900  Other nonmetallic mineral product 
services                                      235710  Concrete contractors                   511000  Publishing industries                 mfg. 
561600  Investigation & security services     235310  Electrical contractors                                                                 
561720  Janitorial services                   235400  Masonry, drywall, insulation, & tile   Broadcasting & Telecommunications             Mining 
561730  Landscaping services                  contractors                                    513000 Broadcasting & telecommunications      212110  Coal mining 
561110  Office administrative services        235210  Painting & wall covering contractors                                                 212200  Metal ore mining 
561420  Telephone call centers (including     235110  Plumbing, heating, & air-              Information  Services &    Data Processing    212300  Nonmetallic mineral mining & 
telephone answering services & telemarketing  conditioning contractors                       Services                                      quarrying 
bureaus)                                      235610  Roofing, siding & sheet metal          514210 Data processing services               211110  Oil & gas extraction 
561500  Travel arrangement & reservation      contractors                                    514100 Information services (including        213110  Support activities for mining 
services                                      235810  Water well drilling contractors        news syndicates, libraries, & on-line           
561490  Other business support services       235900  Other special trade contractors        information services)                         Other Services: 
(including repossession services, court                                                                                                      
reporting, & stenotype services)              Educational Services                           Motion Picture  & Sound      Recording        Personal & Laundry  Services 
561790  Other services to buildings &         611000  Educational services (including        512100  Motion picture & video Industries     812111  Barber shops 
dwellings                                     schools, colleges, & universities)             (except video rental)                         812112  Beauty salons 
561900  Other support services (including                                                    512200  Sound recording industries            812220 Cemeteries & crematories 
packaging & labeling services, & convention   Finance &     Insurance:                                                                     812310  Coin-operated laundries & 
& trade show organizers)                                                                     Manufacturing                                 drycleaners 
                                              Credit  Intermediation &      Related          315000  Apparel mfg.                          812320  Drycleaning & laundry services 
Waste Management  &     Remediation           Activities                                     312000  Beverage & tobacco product mfg.       (except coin-operated) (including laundry & 
Services                                      522100  Depository credit intermediation       334000  Computer & electronic product         dry cleaning drop off & pickup sites) 
562000  Waste management & remediation        (including commercial  banking, savings        mfg.                                          812210  funeral homes & funeral services 
services                                      institutions, & credit unions)                 335000  Electrical equipment, appliance, &    812330  Linen & uniform supply    
                                              522200  Nondepository credit intermediation    component mfg.                                812113  Nail salons 
Agriculture,Forestry, Hunting &               (including sales financing & consumer          332000  Fabricated metal product mfg.         812930  Parking lots & garages  
Fishing                                       lending)                                       337000  Furniture & related product mfg.      812910  Pet care (except veterinary) services 
112900  Animal production (including          522300  Activities related to credit inter-    333000  Machinery mfg.                        812920  Photofinishing 
breeding of cats and dogs)                    mediation (including loan brokers)             339110  Medical equipment & supplies mfg.     812190  Other personal care services 
114110  Fishing                                                                              322000  Paper mfg.                            (including diet & weight reducing centers) 
113000  Forestry & logging (including forest  Insurance Agents, Brokers, &   Related         324100  Petroleum & coal products mfg.        812990  All other personal services 
nurseries & timber  tracts)                   Activities                                     326000  Plastics & rubber products mfg.        
114210  Hunting & trapping                    524210  Insurance agencies & brokers           331000  Primary metal mfg.                    Repair &  Maintenance   
                                              524290  Other insurance related activities     323100  Printing & related support activities 811120  Automotive body, paint, interior, & 
Support Activities for  Agriculture &                                                        313000  Textile mills                         glass repair 
Forestry                                      Securities, Commodity Contracts, &             314000  Textile product mills                 811110  Automotive mechanical & electrical 
115210 Support activities for animal          Other Financial Investments &      Related     336000 Transportation equipment mfg.          repair & maintenance 
production (including furriers)               Activities                                     321000  Wood product mfg.                     811310  Commercial & industrial machinery 
115110  Support activities for crop production  523140  Commodity contracts brokers          339900  Other miscellaneous mfg.              & equipment (except automotive & 
(including cotton ginning, soil preparation,  523130  Commodity contracts dealers                                                          electronic) repair & maintenance 
planting & cultivating)                       523110  Investment bankers & securities        Chemical    Manufacturing                     811210  Electronic & precision equipment 
115310  Support activities for forestry       dealers                                        325100  Basic chemical mfg.                   repair & maintenance 
                                              523210 Securities & commodity exchanges        325500  Paint, coating, & adhesive mfg.       811430  Footwear & Leather goods repair 
Arts, Entertainment, & Recreation:            523120  Securities brokers                     325300  Pesticide, fertilizer, & other        811410  Home & garden equipment & 
                                              523900  Other financial investment activities  agricultural chemical mfg.                    appliance repair & maintenance 
Amusement, Gambling, & Recreation             (including investment advice)                  325410  Pharmaceutical & medicine mfg.        811420  Reupholster & furniture repair 
Industries                                                                                   325200  Resin, synthetic rubber, & artificial 811190  Other automotive repair & 
713100  Amusement parks & arcades             Ambulatory Health Care Services                & synthetic fibers & filaments mfg.           maintenance (including oil change & 
713200  Gambling industries                   621610  Home health care services              325600  Soap, cleaning compound, & toilet     lubrication shops & car washes) 
713900  Other amusement & recreation          621510  Medical & diagnostic laboratories      preparation mfg.                              811490  Other personal & household goods 
services (including golf courses, skiing      621310  Offices of chiropractors                                                             repair & maintenance 
facilities, marinas, fitness centers, bowling 621210  Offices of dentists 
centers, skating rinks) 
                                                                                            ‐14‐ 
       

                                                                          TABLE C - NAICS             CODES 
                                                Enter the Appropriate Six-Digit Number in the Boxes Provided on Page 17, Item O 
Professional, Scientific, & Technical           444110  Home centers                           Miscellaneous Store  Retailers                  421910  Sporting & recreational goods & 
Services                                        444200  Lawn & garden equipment &              453920  Art dealers                             supplies 
541100  Legal services                          supplies stores                                453110  Florists                                421920  Toy & hobby goods & supplies 
541211  Office of certified public accountants  446130  Optical goods stores                   453220  Gift, novelty, & souvenir stores        421990  Other miscellaneous durable goods 
541214  Payroll services                        446110  Pharmacies & drug stores               453930  Manufactured (mobile) home dealers       
541213  Tax preparation services                446190  Other health & personal care stores    453210  Office supplies & stationery stores     Wholesale Trade, Nondurable Goods 
541219  Other accounting services                                                              453910  Pet & pet supplies stores               422300  Apparel, piece goods, & notions 
                                                Clothing & Accessories Stores                  453310  Used merchandise stores                 422800  Beer, wine, & distilled alcoholic 
Architectural, Engineering, &    Related        448130  Children’s & Infant’s clothing  stores 453990  All other miscellaneous store           beverage 
Services                                        448150  Clothing accessories stores            retailers (including tobacco, candle, & trophy  422920  Books, periodicals, & newspapers    
541310  Architectural services                  448140  Family clothing stores                 shops)                                          422600  Chemical & allied products 
541350  Building inspection services            448310  Jewelry stores                                                                         422210  Drugs & druggists’ sundries 
541340  Drafting services                       448320  Luggage & leather goods stores         Non-store Retailers                             422500  Farm product raw materials 
541330  Engineering services                    448110  Men’s clothing stores                  454110  Electronic shopping & mail-order        422910  Farm supplies 
541360  Geophysical surveying & mapping         448210  Shoe stores                            houses                                          422930  Flower, nursery stock, & florists’ 
services                                        448120  Women’s clothing stores                454310  Fuel dealers                            supplies 
541320  Landscape architecture services         448190  Other clothing stores                  454210  Vending machine operators               422400  Grocery & related products 
541370  Surveying & mapping (except                                                            454390  Other direct selling establishments     422950  Paint, varnish, & supplies 
geophysical) services                           Electronic & Appliance Stores                  (including door-to-door retailing,  frozen food 422100  Paper & paper products 
541380  Testing laboratories                    443130 Camera & photographic supplies          plan providers, party plan  merchandisers, &    422700  Petroleum & petroleum products 
                                                stores                                         coffee-break service  providers)                422940  Tobacco & tobacco products 
Computer Systems Design  & Related              443120  Computer & software stores                                                             422990  Other miscellaneous nondurable 
Services                                        443111  Household appliance stores             Transportation & Warehousing                    goods 
541510 Computer systems design & related        443112  Radio, television, & other  electronics  481000 Air transportation  485510  Charter     
services                                        stores                                         bus industry                                    999999    Unclassified establishments 
                                                                                               485510  Charter bus industry                              (unable to classify) 
Specialized Design  Services                    Food & Beverage Stores                         484110  General freight trucking, local 
541400  Specialized design services             445310  Beer, wine, & liquor stores            484120  General Freight trucking, long- 
(including interior, industrial, graphic, &     445220  Fish & seafood markets                 distance 
fashion design)                                 445230  Fruit & vegetable markets              485210  Interurban & rural bus transportation 
                                                445100  Grocery stores (including              486000  Pipeline transportation 
Other   Professional, Scientific, &             supermarkets & convenience stores with-  out   482110  Rail transportation 487000  Scenic & 
Technical Services                              gas)                                           sightseeing transportation 
541800  Advertising & related services          445210  Meat markets                           487000  Scenic & sightseeing 
541600  Management, scientific, & technical     445290  Other specialty food stores            transportation 
consulting services                                                                            485410  School & employee bus 
541910  Market research & public opinion        Furniture & Home Furnishing Stores             transportation 
polling                                         442110  Furniture stores                       484200  Specialized freight trucking 
541920  Photographic services                   442200  Home furnishings stores                (including household moving vans)  
541700  Scientific research & development                                                      485300  Taxi & limousine service   
services                                        Gasoline Stations                              485110  Urban transit systems 
541930  Translation & interpretation services   447100 Gasoline stations (including            483000  Water transportation 
541940  Veterinary services                     convenience stores with gas)                   485990  Other transit & ground 
541990  All other professional, scientific, &                                                  passenger transportation 
technical services                              General Merchandise Stores                     488000  Support activities for transportation 
                                                452000  General merchandise stores             (including motor vehicle  towing) 
Real Estate  & Rental  &  Leasing: Real                                                          
Estate                                          Health & Personal Care Stores                  Couriers  &   Messengers 
531100 Lessors of real estate (including mini   446120  Cosmetics, beauty supplies, &          492000  Couriers & messengers 
warehouses & self-storage units)                perfume stores                                  
531210  Offices of real estate agents &         446130  Optical goods stores                   Warehousing & Storage      Facilities 
brokers                                         446110  Pharmacies & drug stores               493100  Warehousing & storage (except 
531320  Offices of real estate appraisers       446190  Other health & personal care  stores   lessors of mini warehouses & self-storage 
531310  Real estate property managers                                                          units) 
531390  Other activities related to real estate Motor Vehicle & Parts    Dealers                
                                                441300  Automotive parts, accessories, & tire  Utilities 
Rental & Leasing    Services                    stores                                         221000  Utilities 
532100  Automotive equipment rental &           441222  Boat dealers                             
leasing                                         441221  Motorcycle dealers                     Wholesale Trade: 
532400  Commercial & industrial machinery       441110  New car dealers                         
& equipment rental & leasing                    441210  Recreational vehicle dealers           Wholesale Trade, Durable     Goods 
532210  Consumer electronics & appliances       (including motor home & travel trailer         421600  Electrical goods 
rental                                          dealers)                                       421200  Furniture & home furnishing 
532220  Formal wear & costume rental            441120  Used car dealers                       421700  Hardware, & plumbing & heating 
532310  General rental centers                  441229  All other motor vehicle dealers        equipment & supplies 
532230  Video tape & disc rental                                                               421940  Jewelry, watch, precious stone, & 
532290  Other consumer goods rental             Sporting Goods, Hobby,  Book,     & Music      precious metals 
                                                Stores                                         421300  Lumber & other construction 
Religious, Grantmaking, Civic,                  451211  Book stores                            materials 
Professional, & Similar Organizations           451120  Hobby, toy, & game stores              421800  Machinery, equipment, & 
813000  Religious, grantmaking, civic,          451140  Musical instrument & supplies stores    supplies 
professional, & similar  organizations          451212  News dealers & newsstands              421500  Metal & mineral (except petroleum) 
                                                451220  Prerecorded tape, compact disc, &      421100  Motor vehicle & motor vehicle parts 
Retail Trade:                                   record stores                                  & supplies 
                                                451130  Sewing, needlework, & piece goods      421400  Professional & commercial 
Building Material & Garden                      stores                                         equipment & supplies 
Equipment & Supplies Dealers                    451110  Sporting goods stores                  421930  Recyclable materials 
444130  Hardware stores                                                                         
 
                                                                                          ‐15‐ 
        

                                    PAPERLESS/ELECTRONIC FILING 
   
  Multiple opportunities are now available for businesses to file and pay their New Jersey tax and reporting obligations without paper.  These 
  methods are not only convenient but they also decrease potential filing errors, and in most cases provide immediate confirmation of the filing 
  and payment itself. 
                                                                                                                                                  
  As the State of New Jersey moves toward the elimination of paper filing, electronic filing mandates are being established.  In many cases, 
  filers of multiple returns who meet designated thresholds must file electronically.  The State now mandates that all new business registrants 
  use paperless filing and payment methods for selected tax returns and reports.  It is now mandatory to E-file Sales Tax as well as the 
  business’s annual report.  Please visit the Division of Revenue and Enterprise Services (DORES) website at www.nj.gov/treasury/revenue 
  to see the online options that are currently available. 
                                                            
                      ELECTRONIC FUNDS TRANSFER (EFT) PROGRAM 
   
  DORES has established procedures to receive payments, including most tax payments, electronically.  The New Jersey Electronic Funds 
  Transfer (EFT) program manages these payments.  Some businesses are required by statute to remit tax payments electronically.  If your 
  business meets these requirements, you will be notified by the Division of Revenue and sent all necessary information to enroll in the 
  program.  Voluntary participation is also encouraged. 
   
  The EFT Program offers convenient payment options for businesses using the ACH debit method of payment.  If you currently make 
  electronic tax payments via phone, the same taxpayer ID and PIN can be used if you choose the online payment option. 
   
  Online Convenience – Managing electronic transactions from a secure website offers a degree of control and flexibility that isn't available 
  when making payments by phone.  This highly productive online solution is easy to set up and use, and offers several benefits such as a 
  secure website, electronic confirmations, payment tracking, payment history, live phone support, screens that match phone options, and 
  availability from any location, anytime. 
   
  PC Software – This software runs on your desktop computer, and can be obtained free of charge by contacting the EFT Program.  This tool 
  is an ideal option for third party transactions, including payroll companies, tax preparers or accountants managing complex accounts with 
  multiple transactions.  This software is especially useful for companies making a large volume of electronic payment transactions.  Benefits 
  include management of complex multiple payments, electronic confirmations, payment tracking and review of payment history and live 
  phone support. 
   
  Interactive Voice – This technology maximizes phone productivity, and allows you to dial in without having to wait for an operator.  Benefits   
  include availability from any touch-tone phone, voice prompts, and easy to navigate structured options.                                         
   
  Get Started Today – To learn more about these options or to enroll in the EFT program, please visit the Division of Revenue's website at 
  www.nj.gov/treasury/revenue or call 609-292-9292. 
   
                      MORE INFORMATION ON STARTING A BUSINESS 
   
  Complete the card in this packet to receive information about attending a free tax workshop presented by the State of New Jersey.  To request 
  the brochure, “Starting a Business in New Jersey” contact the Division of Taxation’s Call Center at 609-292-6400.  Touch-tone phone users 
  may call our automated line at 1-800-323-4400. 
                                                            
                                           TAXPAYERS’ BILL OF RIGHTS 
   
  The New Jersey Taxpayers’ Bill of Rights simplifies tax administration and ensures that all taxpayers, individuals and businesses alike, 
  receive fair and equitable treatment and receive the information and  assistance  they need to understand and meet  their  State  tax 
  responsibilities. 
   
  For more information on the rights and obligations of both taxpayers and the Division of Taxation under the Taxpayers’ Bill of Rights, 
  contact the Division of Taxation’s Automated Tax Information System from a Touch-tone telephone at 1-800-323-4400 (within New Jersey 
  only) or 609-826-4400 (anywhere). 
                                                            
                                                          ‐16‐ 
 

NJ-REG STATE OF NEW JERSEY    
   (9-2019) DIVISION OF REVENUE AND ENTERPRISE SERVICES   
MAIL TO: 
 *NO FEE REQUIRED* BUSINESS REGISTRATION APPLICATION CLIENT REGISTRATION  
   Please read instructions carefully before filling out this form PO BOX 252  
ALL SECTIONS MUST BE FULLY COMPLETED TRENTON, NJ 08646-0252 
A. Please indicate the reason for your filing this application:   
 ☐ Original application for a new business OVERNIGHT DELIVERY:  
CLIENT REGISTRATION 
 ☐ Moved previously registered business to new location (REG-C-L can be used in lieu of NJ-REG) 33 WEST STATE ST 3 RDFL  
 ☐ Amended application for an existing business  
 TRENTON, NJ 08608  
  Reason(s) for amending application:    Hotline 
 ☐ Application for an additional location of an existing registered business 609-292-9292  
www.nj.gov/treasury/revenue 
 ☐ Applying for a Business  egistration R ertificateC  ☐ Employer of Domestic Household Employee(s)  
    ☐ Withholding for Employee(s) residing in NJ (Not doing business or employing in NJ)         
B. FEIN #   -                OR      Social Security # of Owner    -   -         
 ☐  Check Box if “Applied for”  
REGISTRATION DETAIL C. Name   
  (If your business entity is a Corporation, LLC, LLP, LP or Non-Profit Organization, give entity name.  IF NOT,  give Name of Owner or Partners)  
D. Trade Name   
       
E. Business Location: (Do not use P.O. Box for Location Address)  Mailing Name and Address:F. (if different from business location)  
Street    Name
City  State  Street
Zip Code      City State
 (give 9 digit postal code)     Zip Code     
 (See instructions for providing alternate addresses)                   (give 9 digit postal    code)      
G. Beginning date for this business:   /   / (see instructions) O/C __________
              
 Month   Day Year           
H. Type of ownership (check one):
 ☐ NJ Corporation ☐ Sole Proprietor ☐ Partnership ☐ Out-of-State Corporation ☐ LLP ☐ Other ____________  
   ☐ Limited Partnership  ☐ LLC (1065 Filer) ☐ LLC (1120 Filer) ☐ LLC (Single Member) ☐ S Corporation (you must complete page 41)  
I.  New Jersey Business Code           (see instructions)    ☐ Domestic (Household Employer) FOR OFFICIAL USE ONLY   
 
J. County/Municipality Code  (see instructions) K. County __________________ DLN ___________________  
          
              (New Jersey only) 
L. Will this business be SEASONAL? ☐  YES    ☐  NO              
 If YES – Circle months business will be open: JAN    FEB    MAR          APR    MAY    JUN          JUL    AUG    SEP          OCT    NOV    DEC  
M. If an ENTITY (Item C) complete the following:  
BUSINESS DETAIL  Date of Incorporation: / / State of Incorporation Fiscal Month
       Month  Day  Year                 
           NJ Business/Corp. #              
 Is this a Subsidiary of another corporation? ☐  YES   ☐  NO                   
   If YES, give name and Federal     ID# of parent:                
N. Standard Industrial Code     (if known)  O. NAICS (if known)     
P. Provide the following information for the owner, partners or responsible corporate officers.  (If more space is needed, attach a rider.) 
NAME SOCIAL SECURITY NUMBER HOME ADDRESS PERCENT OF 
(Last Name, First, MI)              TITLE (Street, City, State, Zip Code) OWNERSHIP 
    -  -        
                
DETAIL     -  -        
                
    -  -        
                
OWNERSHIP                 
                                
    -  -        
                
BE SURE TO COMPLETE THE NEXT PAGE 
‐17‐ 
 

                                                                                                                                                                                                              NJ-REG          
  FEIN#: _______________________________________                              NAME: _______________________________________ 
                                                     Each Question Must Be Answered Completely 
   1. a.    Have you or will you be paying wages, salaries or commissions to employees working in New Jersey within the next 6 months? ……..........                                                          ☐ Yes      ☐ No  
            Give date of first wage or salary payment:                                 /            /                                                                                                                         
                                                                               Month      Day            Year                                                                                                                 
      If you answered “No” to question 1.a., please be aware that if you begin paying wages you are required to notify the Client Registration Bureau                                                                         
      at PO Box 252, Trenton NJ 08646-0252, or phone 609-292-9292.                                                                                                                                              
      b.    Give date of hiring first NJ employee:                                     /            /                                                                                                                         
                                                                               Month      Day            Year                                                                                                                 
      c.    Date cumulative gross payroll exceeds $1,000                               /            /                                                                                                                         
                                                                               Month      Day            Year                                                                                                                 
      d.    Will you be paying wages, salaries or commissions to New Jersey residents working outside New Jersey?....................................................  ☐ Yes      ☐ No                                        
      e.    Will you be the payer of pension or annuity income to New Jersey residents? .................................................................................................                    ☐ Yes      ☐ No  
      f. 
            Will you be holding legalized games of chance in New Jersey (as defined in Chapter 47 Rules of Legalized Games of Chance) where                                                                                   
            proceeds from any one prize exceed $1,000? ...................................................................................................................................................   ☐ Yes      ☐ No 
      g.    Is this business a PEO (Employee Leasing Company)? (If yes, see page 6.) .....................................................................................................                   ☐ Yes      ☐ No  
   2. Did you acquire     ☐ Substantially all the assets;     ☐ Trade or business;     ☐ Employees; of any previous employing units? …………..…......                                                           ☐ Yes      ☐ No  
      If answer is “No” go to question 4.                                                                                                                                                                                     
      If answer is “Yes” indicate by a check whether ☐ in whole or ☐ in part, and list business name, address and registration number of 
      predecessor or acquired unit and the date business was acquired by you.  (If more than one, list separately.  Continue on separate sheet if                                                                             
      necessary).                                                                                                                                                                                               
      Name of Acquired                                                -                                                      ACQUIRED                                                                        PERCENTAGE       
      Unit                                                                                                                                                                                                    ACQUIRED 
                                                                                        NJ Employer ID                  ☐ Assets                                                                                          %   
      Address                                                          /                      /                         ☐ Trade or Business                                                                               %   

                                                                                       Month DateDayAcquired Year       ☐ Employees                                                                                     %     
   3. Subject to certain regulations, the law provides for the transfer of the predecessor’s employment experience to a successor where the whole of a business is acquired 
      from a subject predecessor employer.  The transfer of the employment experience is required by law.                                                                                                                     
      Are the predecessor and successor units owned or controlled by the same interests? ………………………………………………………………...…                                                                                        ☐ Yes      ☐ No  
   4. Is your employment agricultural? ……………………………………………………………………………………………………………………..…….……                                                                                                                   ☐ Yes      ☐ No  
   5. Is your employment household? ……………………………………………………………………………………………………………………..…………..                                                                                                                     ☐ Yes      ☐ No  
      a.    If yes, please indicate the date in the calendar quarter in which gross cash wages totaled $1,000 or more           /                  /                                                                          
   6. Are you a 501(c)(3) organization? ….………………………………………………………………………………………………………...………………….                                                                                                                 ☐ Yes      ☐ No  
            If “Yes” to apply for sales tax exemption, obtain form REG-1E at http://www.state.nj.us/treasury/taxation/pdf/other_forms/sales/reg1e.pdf.                                                                        
   7. Were you subject to the Federal Unemployment Tax Act (FUTA) in the current or preceding calendar year? …………………………………..…..…                                                                             ☐ Yes      ☐ No  
      (See instruction sheet for explanation of FUTA.) If “Yes” indicate year:                                                                                                                                                
   8. a.    Does this employing unit claim exemption from liability for contributions under the Unemployment Compensation Law of New Jersey? ...…                                                            ☐ Yes      ☐ No  
         If “Yes” please state reason.  (Use additional sheets if necessary.)                                                                                                                                                  
      b.    If exemption from the mandatory provisions of the Unemployment Compensation Law of New Jersey is claimed, does this employing unit 
            wish to voluntarily elect to become subject to its provisions for a period of not less than two complete calendar years? ………………………                                                               ☐ Yes      ☐ No  
   9. Type of business             ☐   1. Manufacturer                    ☐   2. Service                       ☐   3. Wholesale                                                                                                      
                                   ☐   4. Construction                    ☐   5. Retail                        ☐   6. Government                                                                                                     
        Principal product or service in New Jersey only                                                                                                                                                                              
      Type of Activity in New Jersey only                                                                                                                                                                                            
                                                                                                                                                                                                                                     
  10. List below each place of business and each class of industry in New Jersey, even though you may have only one place of business or engage                                                                                      
      in only one class of industry.                                                                                                                                                                           
       a.   Do you have more than one employing    facility in New Jersey ……………………………………………………………………..………………….                                                                                             ☐ Yes      ☐ No            
  NJ WORK LOCATIONS(Physical location, not mailing address)                             NATURE OF BUSINESS (See Instructions)                                                                                No. of Workers at Each 
                                                                    NAICS                Principal Product or Service Complete Description %                                                               Location and/in Each Class 
    Street Address, City, Zip Code                 County           Code                                                                                                                                      of Industry 

                                                                  (Continue on separate   sheet, if necessary) 
                                                               BE SURE TO COMPLETE THE NEXT PAGE                 

                                                                                       ‐18‐ 
    

                                                                                                                                                        NJ-REG          
 FEIN#: _______________________________________                           NAME: _______________________________________ 
                                             Each Question Must Be Answered Completely 
 11.  a.  Will you collect New Jersey Sales Tax and/or pay Use Tax? ……………………………………………………………..……...                                                     ☐ Yes      ☐ No  
   GIVE EXACT DATE YOU EXPECT TO MAKE FIRST SALE        /                                                   /                                                           
                                                                                    Month           Day        Year
      b.  Will you need to make exempt purchases for your inventory or to produce your product? ……………………..…………….                                       ☐ Yes      ☐ No  
      c.  Is your business located in (check applicable box(es)):          ☐ Atlantic City          ☐ Salem County                                                      
                                                                           ☐ North Wildwood         ☐ Wildwood Crest         ☐ Wildwood                                 
      d.  Do you have more than one location in New Jersey that collects New Jersey Sales Tax? (If yes, see instructions.)...…....                     ☐ Yes      ☐ No  
      e. 
          Do you, in the regular course of business, sell, store, deliver or transport natural gas or electricity to users or customers                                 
          in this state whether by mains, lines or pipes located within this state or by any other means of delivery?.………..……….                        ☐ Yes      ☐ No 
 12.      Do you intend to sell cigarettes? …………………………………………………………………………………………………..…                                                                   ☐ Yes      ☐ No  
          Note:    If yes, complete the REG-L form on page 45 in this booklet and return with your completed NJ-REG. 
                   To obtain a cigarette retail or vending machine license complete form CM-100 on page 44.                                                             

 13.  a.   Are you a distributor or wholesaler of tobacco or nicotine products other than cigarettes?.………………………………...                                  ☐ Yes      ☐ No  
     b.   Do you purchase tobacco or nicotine products other than cigarettes from outside the State of New Jersey?  If yes, you 
          are required to provide supplemental information directly to the Division of Taxation on Form TPT-R, Tobacco and                             ☐ Yes      ☐ No  
          Nicotine Products Registration.  This form is available at https://www.nj.gov/treasury/taxation/prnttobacco.shtml. 
      c.  Do you intend to sell Container E-Liquid?                                                                                                    ☐ Yes      ☐ No  
   
     d.   Are more than 50% of your retail business’s sales derived from Container E-Liquid, electronic smoking devices, and                             Yes      ☐ No  
          related accessories?                                                                                                                         ☐
          Note:    If yes, complete the Vapor Business License Application (form VB-R)  
                   This form is available at https://www.nj.gov/treasury/taxation/prnttobacco.shtml.                                                                    
 14. 
          Are you a manufacturer, wholesaler, distributor or retailer of “litter-generating products”? See instructions for retailer                                    
          liability and definition of litter-generating products.………………………………………………………………………………....                                                    ☐ Yes      ☐ No 
 15.      Are you an owner or operator of a sanitary landfill facility in New Jersey?.………………………………………………..…….                                          ☐ Yes      ☐ No  
   IF YES, indicate D.E.P. Facility # and type (See instructions)                                                                                                       
 16.  a.  Do you operate a facility that has the total combined capacity to store 200,000 gallons or more of petroleum products?                       ☐ Yes      ☐ No  
      b. 
          Do you operate a facility that has the total combined capacity to store 20,000 gallons (equals 167,043 pounds) of                                             
          hazardous chemicals?.………………………………………………………………………………..……………………………….                                                                           ☐ Yes      ☐ No 
      c.  Do you store petroleum products or hazardous chemicals at a public storage terminal?.…………………………………..…                                        ☐ Yes      ☐ No  
   Name of terminal                                                                                                                                                     
 17.  a.  Will you be involved with the sale of petroleum products?…………………………………………………………………………                                                        ☐ Yes      ☐ No  
          Note:    If yes, complete the REG-L form in this booklet and return with your completed NJ-REG. You will be sent a motor fuel license 
                                                                                                                                                                        
                   application (MFA-1) or download this application at https://www.state.nj.us/treasury/taxation/pdf/other_forms/motorfuel/mfa1.pdf.   ☐ Yes      ☐ No 
      b.  Will your company be engaged in the refining and/or distributing of petroleum products for distribution in this state or the 
                                                                                                                                                                        
          importing of petroleum products into New Jersey for consumption in New Jersey?.........……………………………………..                                      ☐ Yes      ☐ No 
      c.  Will your business activity require you to issue a Direct Payment Permit in lieu of payment of the Petroleum Products 
                                                                                                                                                                        
          Gross Receipts Tax on your purchases of petroleum products?.……………………………………………………..…………..                                                     ☐ Yes      ☐ No 
 18. 
          Will you be providing goods and services as a direct contractor or subcontractor to the State, other public agencies                                          
          including local governments, colleges and universities and school boards, or to casino licensees?.………………..……….                               ☐ Yes      ☐ No 
 19. 
          Will you be engaged in the business of renting motor vehicles for the transportation of persons or non-commercial                                             
          freight?.………………………………………………………………………………………………………………………………..…                                                                                 ☐ Yes      ☐ No 
 20.      Is your business a hotel, motel, bed & breakfast or similar facility (or do you provide other transient accommodation                                         
          rentals (e.g., vacation rental, house, room, or similar lodging used on a transient basis) in the State of New Jersey?........               ☐ Yes      ☐ No 
 21.      Will this business be operating in the Sports and Entertainments District of Millville, NJ?..……………………………..…….                                ☐ Yes      ☐ No  
             If yes, will the business be engaged in obtaining gross receipts from any of the following (Circle all that apply if “Yes")                                
             a. Sales, rental or leases of tangible personal property  b. Sales of food & drink  c. Charges of admission  d. Rental charges for hotel occupancies       
 22.      Do you make retail sales of new motor vehicle tires, or sell or lease motor vehicles?.………………………………………...                                     ☐ Yes      ☐ No  
 23.      Do you sell voice grade access telecommunications or mobile telecommunications to a customer with a primary place of                                          
          use in this State?.…………………………………………………………………………………………………………...................                                                               ☐ Yes      ☐ No 
 24.      Contact Information       Person:                                                                    Title:
          Daytime Phone:         (            )______ - ___________       Ext._______________        E-mail Address:                                                    
          Signature of Owner, Partner or Officer:                                                                                                                       
           Title:                                                                                                                   Date:
                                                                                                                                                                        
                                           NO FEE IS REQUIRED TO FILE THIS FORM 
                     IF YOU ARE A SOLE PROPRIETOR OR A PARTNERSHIP WITHOUT EMPLOYEES                                      - STOP HERE - 
                   IF YOU HAVE EMPLOYEES PROCEED TO THE STATE OF NJ NEW HIRE REPORTING FORM ON PAGE 29
 IF YOU ARE FORMING A CORPORATION, LIMITED LIABILITY COMPANY, LIMITED PARTNERSHIP, OR A LIMITED LIABILITY PARTNERSHIP, YOU 
                                  MUST CONTINUE ANSWERING APPLICABLE QUESTIONS ON PAGES 23 AND 24 
                                                                                ‐19‐ 
  

                 If you are a sole proprietor or partnership the following                         
                              information does not pertain to you. 
   
  If you have already filed a new business certificate with our Commercial 
  Recording/Corporate Filing Unit, you need only fill out pages 17-19 of this booklet (NJ-
  REG).  In addition, you need to complete the State of New Jersey New Hire Reporting Form 
  (pages 29-30) if you have employees.  There is no need to complete pages 23-24 of the 
  package if you have successfully filed with Commercial Recording. 

  Applicants who are registering as Sole Proprietors or Partnerships may file online at 
  https://www.njportal.com/DOR/BusinessRegistration or may file pages 17-19, form 
  NJ-REG. Applicants who are registering a new business entity (Limited Liability Company,         
  Limited Partnership, Limited Liability Partnership, or a Corporation), and who have not  
  already filed with Commercial  Recording/Corporate Filing Unit may file online at 
  https://www.njportal.com/DOR/BusinessFormation/Home/Welcome or may complete  the 
  Public Records Filing for New Business Entity  (pages 23-24) in addition to form NJ-REG 
  (pages 17-19). 
   
  The Public Records Filing should be submitted prior to the completion of the NJ-REG to 
  establish the business entity.  However, form NJ-REG must be submitted within 60 days of 
  filing the business entity. 

  Important Note:After you form or authorize your New Business Entity, you will be required 
  to file Annual Reports for the entity.  These reports must be filed annually on the anniversary 
  month of the business entity's formation or authorization.  For your convenience, all major 
  credit cards as well as electronic check (e-check) may be used to pay the filing fee.  A 
                                                                                                   
  reminder notice of your reporting requirement will be sent to your Registered Agent 60 days 
  prior your report’s due date. 
   
  Annual Reports must be filed online at: https://www.njportal.com/dor/annualreports 

                                             ‐20‐ 
  

                                                                                     The cover sheet must include work request details: Name of firm 
   INSTRUCTIONS FOR BUSINESS ENTITY 
                                                                                     or individual transmitting the service request; date of submission; 
             PUBLIC RECORD FILING                                                    depository account number or credit card number with expiration 
                                                                                     date; description of service requested e.g., “Certificate of 
GENERAL INSTRUCTIONS AND DELIVERY/RETURN OPTIONS                                     Incorporation”; business name associated with the filing (proposed 
 
1.  Type or machine print all Public Records Filing forms, and submit with           name for  a new business entity); desired service level 
    the correct FEE amount (See Fee schedule on page 22).                            (EXPEDITED or SAME  DAY);  total number of  pages in the 
     
                                                                                     request transmission, including cover sheet; and fax back number. 
 2. Choose a delivery/return option:                                                  
    a. Regular mail - If you are sending work in via regular mail use the            Note: DORES will accept one filing per FFS.  Requests lacking 
       correct address:                                                              cover sheets or required cover sheet information may be rejected.  
       New Jersey Department of the Treasury                                         Requests that do not contain  a fax back number  will not be 
       Division of Revenue & Enterprise Services/Corp. Filing Unit                   processed.  Also, if a service level is not specified, the Division of 
       PO Box 308                                                                    Revenue will assume that the request is for EXPEDITED service. 
                                                                                      
       Trenton, NJ 08646-0308                                                        DORES will make three attempts  to transmit to  the fax back 
        
       All processed mail-in work  will be returned via regular mail.                number you provide.   If the transmissions are unsuccessful, the 
       Providing a self-addressed return envelope will speed processing.             Division will send acknowledgments of completed filings to the 
       Otherwise, on a cover letter, indicate the return address if other than       registered office of the business entity via regular mail; or hold 
       the registered office of the business entity.                                 rejections in a pending file for two  weeks, and  dispose of the 
                                                                                     material thereafter. 
    b. Expedited/Over-the-Counter - If you are expediting a filing (8.5               
       business hour  processing), make  sure that you deliver over-the-             Receiving  Processed Work Back – For accepted work, the 
       counter to: 33 W. State Street, 5th Floor, Trenton, NJ 08608-1214,            Division of Revenue and Enterprise Services will enter your Public 
       or have a courier/express mail service deliver to this address.  Do           Records Filing and Consolidated Registration application, and fax 
       not use USPS overnight delivery.  Be sure to provide instructions             back an FFS Customer Transmittal with a copy of the approved 
       as to how the filing is to be sent back to you: regular mail; front           Public Records Filing form stamped “FILED”.  For rejected work, 
       desk pick-up at 33 W. State Street; or delivery by courier/express            the Division will fax a FFS Customer Transmittal and Rejection 
       mail.  If you use a courier or  express mail service for return               Notice.   If your submission is rejected, correct  all defects and 
       delivery, be sure to provide a return package and completed air bill          resubmit your filing as a new FFS request. 
                                                                                
       showing your name or company  name (in the “to” and “from”              PAGE 23 INSTRUCTIONS 
       blocks) and your courier account number.                                 
                                                                               LINE BY LINE REQUIREMENTS FOR Public Records Filing 
       Notes: Use an acceptable payment method for mail and over-the-          1. Business Name – Enter a name followed by an acceptable designator 
       counter work:                                                              indicating the type of business entity for example: Inc., Corp., 
            Check/money order payable to the Treasurer, State of NJ;             Corporation, Ltd., Co., or Company for a corporation; LTD Liability Co., 
            Credit card MasterCard, Visa, Discover or AMEX (provide              LTD Liability Company, Limited  Liability Co., Limited Liability 
             card number, expiration date and name/address  of card               Company or L.L.C. for  a  Limited Liability Company; Limited 
             holder);                                                             Partnership or L.P. for a  Limited Partnership; Limited Liability 
            Depository account as assigned by the Treasurer; or                  Partnership or L.L.P. for a Limited Liability Partnership. 
                                                                                   
            Cash.                                                                Note: The  Division will add an appropriate designator if none is 
       For over-the-counter AND mail-in submissions,  remember to                 provided. 
       provide the required number of copies of the Public Record Filing.          
       Filings for for-profit entities are submitted in duplicate and             Remember that the name must be distinguishable from other names on 
       nonprofit filings are done in triplicate.                                  the State’s database.   DORES  will check the  proposed name  for 
                                                                                  availability as part of the filing review  process.   If desired,  you  can 
    c. Facsimile Filing Service (FFS) – Transmit your filings to 609-             reserve/register a name prior to submitting your filing by obtaining a 
       984-6851.   You may request 8.5 business hour processing                   reservation/registration.   For information on name availability and 
       (EXPEDITED SERVICE), or same business day processing                       reservation/registration services and fees, visit the Division’s Web site 
       (SAME DAY SERVICE).  Processing includes document review,                  at www.nj.gov/treasury/revenue or call 609-292-9292 Monday - Friday, 
       fee accounting and acknowledgment turnaround.                              8:30 a.m. - 4:30 p.m. 
                                                                                   
       Payment Methods –     You may pay for services via credit card          2. Type of Business Entity  – Enter the two or three letter code that 
       (MasterCard/Visa,  Discover and  AMEX) or depository account               corresponds with the type of business you are forming/registering: 
       (one payment method per request). 
                                                                                   Statutory Authority    Entity Type                        Type Code 
       Delivery/Turnaround –  Barring difficulties beyond DORES                    Title 14A              Domestic Profit                            DP 
       control, including those that affect the Division’s data                    For-Profit Corp.       Domestic Professional                      PA 
       communication  or data processing systems, all EXPEDITED                                           Foreign Profit                             FR 
       requests delivered to the FFS workstation between 8:30 a.m. and                                    (Incl. Foreign Professional Corp.)          
       5:00 p.m. on workdays will be processed and returned within 8.5                                    Foreign Profit                              
       business hours,  while SAME  DAY requests delivered by 12:00                                       “Doing Business As” (DBA)                  DBA 
       noon on workdays will be processed by 5:00 p.m. the same day.                                       
       Requests received during off hours, weekends or holidays will be            Title 15A              Domestic Non-Profit                        NP 
       processed on the next work day, in 8.5 business hours.  In the event        Non-Profit Corp        Foreign Non-Profit                         NF 
       of down time, upon system recovery, requests will be processed in                                   
       receipt date/time order.                                                    Title 42:2B            Domestic LLC                               LLC 
                                                                                   Limited Liability Co.  Foreign LLC                                FLC 
       Cover Sheet – with your transmission, send a cover sheet entitled:                                  
             New Jersey Department of the Treasury                                 Title 42:2A            Domestic LP                                LP 
             Division of Revenue and Enterprise Services                           Limited Partnership    Foreign LP                                 LF 
             Facsimile Filing Service Request                                                              
                                                                                   Title 42               Domestic LLP                               LLP 
                                                                                   Limited Liability      Foreign LLP                                FLP 
                                                                                   Partnership 
                                                                      ‐21‐ 
 

3. Business Purpose – Provide a brief description of the business purpose         9.  Management – For profit and professional corporations list initial Board 
   for the public record.  If the business is a domestic for-profit corporation,      of Directors, minimum of 1; domestic non-profits list Board of Trustees, 
   you may leave this field blank and thereby rely on the general purpose             minimum of 3; limited partnerships list all General Partners. 
                                                                                       
   clause provided in N.J.S.A. 14A:  “The purpose for which  this                 10. Incorporators –    Domestic profit, professional and non-profit 
   corporation is organized is(are) to  engage in any activity within the             corporations only, list incorporators, minimum of 1. 
   purposes for which corporations may be organized under  N.J.S.A.                
   14A:1-1 et seq.”                                                               Signature Requirements for Public Records Filing: 
                                                                                  The incorporator(s) and only the incorporator(s) may sign domestic profit, 
4. Stock – Domestic for-profit corporations only, list total shares.              professional and non-profit corporate filings.  Only the president, VP or Chief 
       
5. Duration – List the duration of the entity.  If the duration is indefinite or  Executive Officer may sign foreign corporate filings.  ALL general partners 
   perpetual, leave the field blank.                                              must sign limited partnership filings.  ANY authorized representative may 
    
6. State of Formation/Incorporation – Foreign entities only, list home            sign domestic or foreign limited liability company filings, while any 
   state.                                                                         authorized partner may sign domestic or foreign limited liability partnership 
                                                                                  filings. 
7. Date of Formation/Incorporation – Foreign entities only, list the date          
   of incorporation/formation in home state.                                      PAGE 24 INSTRUCTIONS 
                                                                                  11. Provide additional “Entity-Specific” information as applicable. 
8. Contact Information – Provide the following information:                           Nonprofit corporations wanting Federal IRS section 501(c)(3) status 
   a. Registered Agent – Enter one agent only.  The agent may be an                   are advised to consult the IRS concerning IRS required wording.  
      individual or a corporation duly registered, and in good standing               The IRS telephone number is 1-877-829-5500, and the website is at 
      with the State Treasurer.                                                       www.irs.gov. 
       
   b. Registered Office – Provide a New Jersey street address.  A PO                   
      Box may be used only if the street address is listed as well.                    
                                                                                       
   c. Main Business Address – List the main business address. 
 
                                      CHECKLIST FOR PUBLIC                            RECORDS FILING 
      *    Completed and signed Public Records Filing (pages 23 and 24) (Note: Use appropriate envelope supplied - P.O. Box 308) 
      *    Filing fee using an acceptable payment method. 
      *    Transmittal letter or service request sheet with instructions for returning completed work (mail and over-the-counter requests) 
      *    Cover sheet listing work request details (FAX Filing Requests) 
                                                                                                                                                       
                           CHECKLIST FOR BUSINESS REGISTRATION                                     APPLICATION 
      *    Completed and signed Business Registration Application (pages 17-19) 
      *    Completed and signed CM-100 (Combined Cigarette License Application, if applicable) 
      *    Completed and signed CBT-2553 (S Corporation Election) if applicable 
            
   Delivery Options for:                          
   Public Records Filings:                                                        Business Registration Application:                                   
                     Mail:  Po Box 308, Trenton, NJ 08646                                          Mail:  Po Box 252, Trenton, NJ 08646 
          Over-The-Counter  33 West State Street 5  Floorth                                   Overnight:  33 West State Street 3  Floorrd
                           Trenton, NJ 08608-1214                                                          Trenton, NJ 08608-1214                      
                    Phone:  609-292-9292                                                           Fax:  609-984-6851 
                     Fax:  609-984-6851 
                                                            FEE SCHEDULE 
                                                            (Revised 4/20/2011) 
   FAX FILING SERVICE FEES (FFS)  
          Each EXPEDITED FFS request is subject to a $15 fee, plus $.10 cents per page fee for all accepted filings that are FAXED back 
           for all Title 14A, Title 15A, and LP transactions.  For LLCs and LLPs, each EXPEDITED FFS request is subject to a $25 fee, plus 
           $.10 cents per page fee for all accepted filings that are FAXED back. 
          Each SAME DAY FFS request is subject to a $50 fee, plus a $.10 cents per page fee, for all accepted filings that are FAXED back. 
          These fees are in addition to the basic statutory fees associated with the filing itself. 
          We also offer a one and two hour expedited service.  The fees per filing are $1,000 and $500 respectively. 
    
   BASIC FILING FEES                                                                                                                                   
          Filing fee for all domestic entities, except non-profits, is $125 per filing; non-profit filing fee is $75 per filing. 
          Filing fee for all foreign entities is $125 per filing. 
    
   SERVICE FEES AND OTHER OPTIONAL FEES (All added to basic filing fee, if selected) 
          Expediting Service Fee (8.5 business hours) is $15 per filing request for Title 14A, Title 15A and LP transactions. 
          Expediting Service Fee (8.5 business hours) is $25 per filing request for LLCs and LLPs. 
          Same Day Fee is $50 per filing request. 
          Alternate Name Fee is $50 for each name. 
          FAX Page Transmission Fee is $.10 cents per page for all filings that are FAXED back. 
          Certified Copies of Accepted Filings are $25 for each filed entity. 
    
                                                                     ‐22‐ 
 

Mail to:                                                                                                                   Overnight to: 
         PO Box 308                                          STATE OF NEW JERSEY                                           33 West State St 5 thFL 
     Trenton, NJ 08646         DIVISION OF REVENUE AND ENTERPRISE SERVICES                                                       Trenton, NJ 08608 
     FEE REQUIRED              PUBLIC RECORDS FILING FOR NEW BUSINESS ENTITY                                                                
 
Fill out all information below INCLUDING INFORMATION FOR ITEM 11, and sign in the space provided.  Please note that once filed, this         form 
constitutes your original certificate of incorporation/formation/registration/authority, and the information contained in the filed form is considered public.  
Refer to the instructions for delivery/return options, filing fees and field-by-field requirements.  Remember to remit the appropriate fee amount.  Use 
attachments if more space is required for any field, or if you wish to add articles for the public record. 
 
1.    Business Name:
       
2.    Type of Business Entity:  _____  _____  _____                                   3. Business Purpose: 
      (See instructions for Codes, Page 21, Item 2)                                      (See instructions for Codes, Page 21, Item 3) 
4.    Stock (Domestic Corporations only; LLCs and Non-Profits leave blank             5. Duration (If Indefinite or Perpetual, leave blank): 
                                                                                          
6.    State of Formation/Incorporation (Foreign Entities Only):                       7. Date of Formation/Incorporation (Foreign Entities Only):
       
8.    Contact Information:
       
      Registered Agent Name ____________________________________________________________________ 
                                                                              
      Registered Office:                                                     Main Business or Principal Business Address: 
      (Must be a New Jersey street address)                                   
                                                                              
      Street__________________________________________________               Street__________________________________________________ 
                                                                              
      City____________________________  Zip____________________              City_____________________  State_______  Zip_______________ 
                                                                              
9.    Management (Domestic Corporations and Limited Partnerships Only) 
            For-Profit and Professional Corporations list initial Board of Directors, minimum of 1; 
            Domestic Non-Profits list Board of Trustees, minimum of 3; 
            Limited Partnerships list all General Partners. 
                          Name                                     Street Address                          City            State             Zip

The signatures below certify that the business entity has complied with all applicable filing requirements pursuant to the laws of the State of New Jersey. 
                                                                          
10.   Incorporators (Domestic Corporations Only,  minimum of 1) 
                          Name                                     Street Address                          City            State             Zip

                          Signature(s) for the Public Record (See instructions for information on Signature Requirements) 
                                                                          
                          Signature                                        Name                                 Title                      Date

                                                                        ‐23‐ 
  

                          Public Records Filing for New Business Entity (continued) 
 
11. Additional Entity – Specific Information 
  
    A.  Domestic Non-Profit Corporations (Title 15A) - For IRS exemption considerations, see instructions 
       1a. The corporation shall have members:………………………………………………..…………                                                                ☐ Yes      ☐ No 
   If yes, qualification shall be:                                                                                                     
   ☐ As set forth in the by-laws    or     ☐As set forth herein: 
    
       1b. The rights and limitations of the different classes of members shall be: 
   ☐ As set forth in the by-laws    or     ☐ As set forth herein:    
    
       2.  The method of electing the trustees shall be: 
   ☐ As set forth in the by-laws    or     ☐ As set forth herein:    
    
       3.  The method of distribution of assets shall be: 
   ☐ As set forth in the by-laws    or     ☐ As set forth herein:    
    
    B. Foreign Corporations - Profit, Non-Profit and Foreign Legal Professional (Titles 14A and 15A) 
  Attach a certificate of good standing/existence from the state of incorporation not greater than 30 days old to this form. 
    
    C.  Limited Partnerships (Title 42:2A) 
       1.  Set forth the aggregate amount of cash and a description and statement of the agreed value of other property or services contributed 
           (or to be contributed in the future) by all partners: 
    
       2.  Do the limited partners have the power to grant the right to become a limited partner to an 
           assignee of any part of their partnership………………………………………………………..                                                           ☐ Yes      ☐ No 
   If yes, list the terms/conditions of that power:                                                                                    
    
       3.  Do the limited partners have the right to receive distributions from a partner which includes a 
           return of all or any part of the partner’s contributions?................................................................. ☐ Yes      ☐ No 
   If yes, list the applicable terms:                                                                                                  
    
       4.  Do the general partners have the right to make distributions to a partner which includes a 
           return of all or any part of the partner’s contributions?................................................................. ☐ Yes      ☐ No 
   If yes, list the applicable terms:                                                                                                  
                                                                                                                                       
       5.  What are the rights of the remaining general partners to continue the business in the event that                            
           a general partner withdraws?  List below: 
                                                                                                                                       
    D.  Foreign Limited Partnerships (Title 42:2A) 
   Set forth the aggregate amount of cash and a description and statement of the agreed value of                                       
           other property or services contributed (or to be contributed in the future) by all partners: 
   
                                                                 ‐24‐ 
  

                                                         Instructions 

                           Registration of Alternate Name (Form C-150G) 

Business entities that are registering an alternate business name may file online at https://www.njportal.com/dor/businessamendments.  
This online service allows you to file New Jersey Business Charter amendments online and receive a certificate that confirms your 
filing has been accepted and added to the public record. 
------------------------------------------------------------------------------------------------------------------------------------------------------------------ 
Important: The completion of all items is mandatory in order to process your application. 
 
First, check off the Statutory Authority that applies to your business. 
 1.  Enter the name of the corporation/business exactly as it appears on the records of the Treasurer of the State New Jersey. 
 2.  Enter the 10-digit Corporation/Business ID number as issued by the State of New Jersey. 
 3.  Enter the name of the State in which the corporation was incorporated. 
 4.  Enter the date of incorporation (domestic corporations) or the date of authorization (foreign corporations). 
 5.  Enter the alternate name that you wish to have registered. 
      
Warning: Do Not Use a name that is prohibited by other New Jersey State Laws – for example, those governing banking, insurance, 
and real estate, or involving the Professional Services Act in Title 14A.  While checking on usage limitations is not a mandatory review 
element for the Corporate Filing Section, the Section will reject or void filings upon advice and guidance of regulatory and licensing 
authorities.  The filer is responsible for researching regulatory and licensing issues. 
 
 6.  State the purpose of the business or the primary type of activity performed by the business, under the alternate name given 
     above. 
 7.  No entry is required. 
 8.  If the alternate name was previously used, enter the month and year such use commenced. 
 
ATTESTATIONS: 
Form C-150G provides the following statements:  
         1) the corporation intends to use the alternate name in New Jersey and 
         2) the corporation has not used the name in violation of the law, or if it has, the month/year in which it commenced such 
            use. 
 
EXECUTION: 
You must have the correct business representative sign and date form C-150G before submitting.  Refer to the specific requirements for 
each type of business. 
 
FEE: 
You must attach the mandatory fee of $50.00 to the completed C-150G application. 
 
These documents should be filed in duplicate.  Non-profits should file in triplicate. 
Make checks payable to: Treasurer, State of New Jersey (No cash, please) 
Mail to:   NJ Division of Revenue and Enterprise Services 
      PO Box 308 
      Trenton, NJ 08646 
                             
                                                          ‐25‐ 
 

Mail to:                                                                                              Overnight to: 
          PO Box 308                        STATE OF NEW JERSEY                                                 33 West State St 5 thFL 
     Trenton, NJ 08646           DIVISION OF REVENUE AND ENTERPRISE SERVICES                                     Trenton, NJ 08608 
     FEE REQUIRED                         REGISTRATION OF ALTERNATE NAME                                                         
 
 C-150G 
Complete the following applicable information, and sign in the space provided.  Please note that once filed, the information contained in the filed 
form is considered public.  Refer to the instructions on page 25 for filing fee and field-by-field requirements.  Remember to remit the 
appropriate fee amount.  Use attachments if more space is required for any field. 
 
          ☐                                                                       ☐           Title 42:2B-4 Limited Liability Company 
                   Title 14A:2-2.1 (2) New Jersey Business Corporation Act 
                                                                                    
          ☐                                                                       ☐           Title 42:2A-6 Limited Partnership 
                   Title 15A:2-2-3 (b) New Jersey Nonprofit Corporation Act 
 
Pursuant to the provisions of the appropriate statute, checked above, of the New Jersey Statutes, the undersigned corporation/business entity hereby 
applies for the registration of an Alternate Name in New Jersey for a period of five (5) years, and for that purpose submits the following 
application: 

  1.     Name of Corporation/Business:     
           
  2.     NJ 10-digit ID number:   
           
  3.     Set forth state of Original Incorporation/Formation:   
           
  4.     Date of Incorporation/Formation:   

         Date of Authorization (Foreign):   
           
  5.     Alternate Name to be used:    
           
  6.     State the purpose or activity to be conducted using the Alternate Name:   
           
  7.     The Business intends to use the Alternate Name in this State.      
         The Business has not previously used the Alternate Name in this State in violation 
  8.                                                                                           
         of this Statute, or if it has, the month and year in which it commenced such use is: 
                                                                                               
         Signature requirements:                                                               
         For Corporations                                                   Chairman of the Board, President, Vice President 
         For Limited Partnerships                                           General Partner 
         For all Other Business Types                                       Authorized Representative 

         Signature                                                          Title
             
         Name (please type)                                                 Date                                 
                                                                                                                 
  THE PURPOSE OF THIS FORM IS TO SIMPLIFY THE FILING REQUIREMENTS.  IT DOES NOT 
                            REPLACE THE NEED FOR COMPETENT LEGAL ADVICE. 
   
                                                                       ‐26‐ 
  

                   NEW JERSEY NEW HIRE REPORTING DIRECTORY 
                                                            
On March 5, 1998, Governor Whitman signed into law the New Jersey Child Support Act, P.L. 1998, C.1.  The Act requires all New 
Jersey employers to report basic information about employees who are newly hired, rehired, or who return to work after a separation of 
employment.  This information will be used principally to help locate parents who owe child support.  It will also be used to identify 
recipients of public assistance and unemployment compensation who fail to report earnings. 
 
If you are interested in reviewing either P.L. 1998, C.1 or the regulations promulgated by the Department of Human Services to 
implement the provisions of the law, you may do so through the following sources: the law is available at the New Jersey State Law 
Library 609-292-6230 and the regulations were published in the New Jersey State Register on June 1, 1998 and are available at most 
public libraries. 
 
HOW IT WORKS 
 
New Hire information provided by employers will be compiled on a computer file and will be compared to the database of individuals 
who are required to pay child support.  When a “match” occurs, a notice is sent to the child support obligor’s employer, notifying the 
employer to withhold child support and remit the funds in accordance with the income withholding notice. 
 
The New Hire file is compared to databases of applicants and recipients of various compensation benefits.  Match information is used 
in determining if these individuals are reporting earnings as required.  This screening process will save taxpayers millions of dollars 
each year by preventing and detecting fraud. 
 
WHO REPORTS 
 
      All employers with business operations in New Jersey are required to submit New Hire Reports unless you are a multi-state 
       employer and have notified the federal government as required by P.L. 104-193. 
      Some payroll processing services automatically report newly-hired employees.  If you use a payroll processing service, ask if 
       they send reports on behalf of your organization. 
 
WHO MUST BE REPORTED 
 
      All newly hired employees who work in New Jersey must be reported.  If you are unsure whether an individual is an “employee” 
       consult New Jersey Law P.L. 1998, C.1. 
      Employees who are returning to the payroll after a lapse in employment and for whom a W-4 must be completed. 
 
WHEN TO SEND REPORTS 
 
      If reporting through electronic media, submit the new hire report within 15 days of the employee’s first day on the job. 
      If submitting by any other means, submit within 20 days of the employee’s first day on the job. 
 
  QUARTERLY WAGE REPORTS SUBMITTED TO THE NJ DEPARTMENT OF THE TREASURY, DIVISION OF REVENUE 
  AND ENTERPRISE SERVICES, DO NOT SATISFY THE OBLIGATION TO SUBMIT TIMELY NEW HIRE REPORTS 
 
WHAT TO REPORT 
 
      The employer’s Federal Employer Identification Number (FEIN), including company name and address. 
      The employee’s Social Security number, name and address. 
      Employee’s date of birth, if available. 
      Employee’s date of hire, optional (currently reported by many payroll processing companies). 
 
HOW TO REPORT 
 
 Mail: New Hire Operations Center              Toll Free Numbers:                                      Online: 
       PO Box 4654                             FAX:         1-800-304-4901                             https://njcsesp.com 
       Trenton, NJ 08650-4654                  Telephone:   1-877-NJ-SHARES                             
       Contact our New Hire Operations Center at (toll-free) 1-877-NJ-HIRES to obtain a version of this document in Spanish. 
                                                            
       Para obtener una versi n en español de este documento o para recibir ayuda, por favor comuniquese con nuestro 
                   Centro de operaciones gratis para nuevos empleados al (toll-free) 1-877-NJ-HIRES. 
  
                                                          ‐27‐ 
 

REPORTING FORMATS (Please choose only 1 of the following 4 reporting methods) 
 
   1. Paper Lists or Printouts: This method can be used for reporting several newly hired employees at once. 
      Mail lists to our New Hire Operations Center or fax lists to 800-304-4901, using the following format: 
       
                                                    PAPERLIST or PRINTOUTS 
                                                                      
    Federal Employer Identification Number:              XXX-XXX-XXX 
    Employer Payroll Address                             Wigit International, Inc. 
                                                         75 Curbside Lane 
                                                         Somewhere, NJ 08601 
 
            SSN         First Name  MI   Last Name       Address           City    State Zip       Date of   Date of Birth    Gender 
                                                                                                   Hire(opt) (if Available) (optional) 
    XXX-XX-XXXX         ROBERT        C  CLARKE     34 PERKINS DR     NEWBURN      NJ    08652  10/23/97     08/06/59         M 
    XXX-XX-XXXX         ANGELA        R  SMITH      111 MAIN ST       TRENTON      NJ    08603  10/06/97     12/03/87         F 
    XXX-XX-XXXX         DAVID         J  CARBO      12 GREEN ST       READING      NJ    08127  10/03/97     04/26/66         M 
 
   2. NJ New Hire Reporting Form: The attached form can be used to report individual employees and can be photocopied.  Refer 
      to it for instructions for completing the required information.  Mail a copy to our New Hire Operation Center or Fax it to 800-
      304-4901.  To obtain copies of these forms visit our World Wide Web site at https://njcsesp.com/files/NJForm.pdf.  
       
   3. A Copy of a W-4 Form: Employers may also use W-4 forms to report.  After the employee completes his or her information 
      (lines 1-7), add the employer’s name, and address, (line 8) and FEIN (line 10).  To obtain copies of W-4 forms, call the U.S. 
      Internal Revenue Service at 1-800-829-3676. 
       
   4. Electronic Media: Call the NJ  Operations Center at (toll-free)  1-877-NJ-HIRES, for  technical support, for certification 
      information, and mailing of electronic media to our New Hire Operations Center.  Acceptable electronic media are 3.5” 
      diskettes, round magnetic tapes, and cartridges. 
       
MULTI-STATE REPORTING BY EMPLOYERS 
 
Beginning October 1, 1997, an employer that has employees in two or more states and transmits reports electronically may report all 
new hires to one state if the employer does both of the following: 
 
1) Notifies the United States Secretary of Health & Human Services, in writing, of which state the employer has designated to receive 
   the report. 
2) Transmits the report to that state in compliance with federal and state law. 
    
If you are a multi-state employer and you elect to send New Hire reports to New Jersey, you must first notify the federal government of 
your request at the following address: 
                                            Department of Health and Human Services 
                                            Federal Office of Child Support Enforcement 
                                                  Multi-state Employer Registration 
                                                         Post Office Box 509 
                                                    Randallstown, Maryland 21133 
                                                          202-401-9267 
QUESTIONS 
 
Please direct any questions regarding New Hire Reporting to the New Jersey Operations Center at    https://njcsesp.com or our e-mail 
address at newjersey@nj-newhire.com or call customer service directly at 1-877-NJ-HIRES (toll free).                                     

                                                                 ‐28‐ 
 

                      STATE OF NEW JERSEY NEW HIRE REPORTING FORM 
                                                    
       Please mail to: New Jersey New Hire Operations Center, PO Box 4654, Trenton, NJ 08650-4654 
 
   TO ENSURE ACCURACY, PLEASE PRINT (OR TYPE) NEATLY IN UPPER-CASE LETTERS AND 
                            NUMBERS, USING A DARK, BALL POINT PEN 
                                                    
  Employer Federal EIN     ___ ___ - ___ ___ ___ ___ ___ ___ ___  

  Employer Information:     

  Employer Name       ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 
  (Name, d/b/a, ect.) 

  Employer Payroll Address  
   
  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 
 
  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 

  Employer Payroll City                                                State           Zip Code + 4 (optional) 

  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___  ___  ___  ___ ___ ___ ___ ___ - ___ ___ ___ ___
                                                    
  Employee Information: 

  Employee Social Security Number    ___ ___ ___ - ___ ___ - ___ ___ ___ ___ 

  First Name ___ ___ ___ ___ ___ ___ ___ ___ ___    MI (opt) ___       Last Name ___ ___ ___ ___ ___ ___ ___ ___ ___ 

  Employer Payroll Address  
   
  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 
 
  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 

  City                                                                 State           Zip Code + 4 (optional) 

   ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___  ___  ___ ___ ___ ___ ___ - ___ ___ ___ ___

             Date of Hire (optional)                   Date of Birth (if available)    Gender (optional) 

       ___ ___ - ___ ___ - ___ ___ ___ ___         ___ ___ - ___ ___ - ___ ___ ___ ___ ☐ Male      ☐Female 

                                    THIS FORM MAY BE REPRODUCED 

                                           ‐29‐ 
  

  Employer Federal EIN     ___ ___ - ___ ___ ___ ___ ___ ___ ___  
                            
  Employee Information: 

  Employee Social Security Number    ___ ___ ___ - ___ ___ - ___ ___ ___ ___ 

  First Name ___ ___ ___ ___ ___ ___ ___ ___ ___   MI (opt)  ___       Last Name ___ ___ ___ ___ ___ ___ ___ ___ ___ 

  Employer Payroll Address  
   
  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 
 
  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 

  City                                                                  State          Zip Code + 4 (optional) 

   ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___  ___  ___ ___ ___ ___ ___ ___ - ___ ___ ___ ___

             Date of Hire (optional)                   Date of Birth (if available)    Gender (optional) 

       ___ ___ - ___ ___ - ___ ___ ___ ___         ___ ___ - ___ ___ - ___ ___ ___ ___ ☐ Male      ☐Female 
                                                                                                     
  Employee Information: 

  Employee Social Security Number    ___ ___ ___ - ___ ___ - ___ ___ ___ ___ 

  First Name ___ ___ ___ ___ ___ ___ ___ ___ ___   MI (opt)  ___       Last Name ___ ___ ___ ___ ___ ___ ___ ___ ___ 

  Employer Payroll Address  
   
  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 
 
  ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 

  City                                                                  State          Zip Code + 4 (optional) 

   ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___  ___  ___ ___ ___ ___ ___ ___ - ___ ___ ___ ___

             Date of Hire (optional)                   Date of Birth (if available)    Gender (optional) 

       ___ ___ - ___ ___ - ___ ___ ___ ___         ___ ___ - ___ ___ - ___ ___ ___ ___ ☐ Male      ☐Female 

                                    THIS FORM MAY BE REPRODUCED 

                                           ‐30‐ 
  

                            The Child Support Program and Employers 
                                                            
The Child Support Program and Employers 
 
Employers play a vital role in helping to ensure the financial security of millions of our nation’s children by working cooperatively with 
the Child Support Enforcement Program. 
 
The Child Support Enforcement Program has been at work since 1975 when it was established by Congress under Title IV-D of the 
Social Security Act to collect child support payments for children in single-parent families.  Although it has expanded greatly since its 
inception, the program’s goals are still the same: 
     
    To ensure that children are financially supported by both parents 
     
    To reduce public assistance expenditures 
     
State and local programs provide five basic child support enforcement services: 
 
 1. Locating non-custodial parents 
 2. Establishing paternity (legal fatherhood) 
 3. Establishing child support and medical support orders 
 4. Collecting and distributing child and medical support 
 5. Enforcing child and medical support orders 
 
How Employers Are Helping 
 
The following are some ways that employers who comply with child support laws help their communities: 
 
    Deducting for child and medical support obligations: Nearly 60% of all monies collected on behalf of America’s children is 
    collected by employers through income withholding. 
     
    Saving taxpayers’ dollars: Child support collections reimburse public assistance spending and reduce costs for other social 
    programs such as Medicaid and food stamps because fewer children remain in poverty.  The Child Support Enforcement 
    Program reduces government spending on welfare by increasing child support collections for families who would otherwise be 
    forced to seek public assistance. 
     
    Prevent or reduce fraud: State agencies operating unemployment insurance and workers’ compensation programs use new hire 
    employment information to detect and prevent erroneous benefit payments and erroneous receipt of public assistance payments. 
 
Employers’ Responsibilities 
 
New Hire Reporting 
 
New hire reporting is the process by which you, as an employer, report information on your newly hired employees to a designated state 
agency shortly after the date of hire.  New hire reports are matched against child support records at the state and national levels to locate 
parents who are not paying child support.  This is especially helpful for interstate cases (in which one parent lives in a different state 
from his or her child), which are often the most difficult cases for states to resolve. 
 
With new hire reporting, state child support enforcement agencies have the ability to issue income withholding orders--the most effective 
means of collecting child support--much more quickly. 
 
The new hire report must include, at a minimum, the following information, found on a W-4 form: 
     
    Employee name, address, and Social Security number 
     
    Employer name, address, and Federal Employer Identification Number (FEIN) 
    (Some states may require or request additional data.) 
     
Employers have 20 days to report their new hires to the state.  (Some states have established more stringent reporting requirements.) 
     
If you are reporting your new hire reports electronically or by magnetic media, you must report twice a month (if necessary). 
 
                                                          ‐31‐ 
 

Multistate Employers’ New Hire Reporting Option 
 
Multistate employers, those with employees working in more than one state and that report electronically, may select one of the following 
reporting options: 
 
 1. Report each newly hired employee to the state in which he/she is working, following the new hire regulations, requirements, 
    and time frames of each state to which you report; or 
     
 2. Select one state where you have employees working and report all new hires to that state electronically. 
 
If you choose the second option (to report new hire data on all employees to only one state), you must notify the Secretary of the U.S.  
Department of Health and Human Services as to which state you have designated to receive all your new hire information.  For 
information on how to notify the Secretary: 
 
   Call the Office of Child Support Enforcement (OCSE) Information Line: (202) 401-9267, 7:30 a.m. – 5:30 p.m. ET 
   Visit the OCSE employer website at https://ocsp.acf.hhs.gov/csp/home/employer.  
 
Income Withholding 
 
Income or wage withholding by employers is the most effective method of child support collection.  Income withholding is the court-or 
administrative agency-ordered deduction of child and medical support obligations from a parent’s income.  The employer deducts the 
specified amount each pay period and sends it to the agency responsible for receiving and accounting for child support. 
 
Direct income withholding allows one state to send an income withholding order to a non-custodial parent’s employer in another state.  
While income withholding for child support is not new for employers, receiving an order directly from another state may be new to you. 
 
Most states are now using a standard income withholding order developed by OCSE.  If the income withholding order appears “regular 
on its face” you must honor it and  
 
    Provide a copy of the order/notice to the employee immediately. 
     
    Begin income withholding and send the payments to the address cited in the withholding order/notice. 
     
    Continue to honor the withholding order/notice until you receive official notification from the child support enforcement 
    agency/court to stop or make a change to the withholding. 
 
Income withholding for child and medical support has priority over all other legal processes against income except for federal tax liens 
that were served before the child support order was served. 
 
Income withholding for child and medical support may not exceed the maximum amount allowed under the Consumer Credit Protection 
Act (CCPA) and similar state laws. 
 
Medical Support 
 
Medical support is a form of child support often provided as health care insurance under a parent’s policy.  If neither parent has health 
care insurance, the child support order may provide for a specific dollar amount to be deducted for medical purposes.  Employers are 
required to honor medical support orders established under state law.  A court or administrative agency may require your employee to 
provide health insurance for his/her dependents.  Courts require coverage if it is available to an employee at a “reasonable cost” defined 
as coverage available through the employer or other group health insurance (for example, a union). 
 
You may receive an order from the court or administrative agency to enroll an employee’s dependents in an insurance plan and withhold 
premiums from the employee’s wages.  This order may be in addition to an order to withhold a monetary child support obligation. 
 
                                                            ‐32‐ 
 

What Do I Need to Know about Medical Support? 
 
Employers and health insurance providers need to know that: 
 The dependent(s) must be enrolled in a family insurance plan without regard to seasonal restrictions (i.e., open enrollment). 
  
 The dependent(s) may not be denied coverage on the grounds that the parents were never married, that the dependent is not 
 claimed on the employee’s federal income tax return, or that the dependent does not reside with the employee or in the insurer’s 
 service area. 
  
 The employee may not eliminate coverage of the dependent unless the employee provides written proof that the order is no 
 longer in effect or that the dependent will be enrolled in a comparable health insurance plan elsewhere. 
 
New Features to Help Employers 
 
Centralized Collections 
 
As  of  October 1,  1999, each state child support enforcement agency is required to  have a centralized, computerized  unit  (State 
Disbursement Unit) for the collection and disbursement of child support.  Therefore, you may no longer have to send checks to multiple 
localities in a state. 
 
State Disbursement Units (SDUs) handle payments for all orders enforced by the child support enforcement agency, plus all private 
child support cases (non-IV-D cases) for which an order was issued on or after January 1, 1994, requiring income withholding as the 
method of payment. 
 
Some states require all payments to be sent to the SDU. 
 
Benefits of Centralized Collections 
 
 Reduced check processing cost 
  
 Reduced postage and handling cost 
  
 Opportunity to use electronic transmission of payments and payment information 
  
 Faster payments to children and families, resulting in fewer calls to employers and non-custodial parents 
 
Many state child support agencies now offer payment by Electronic Funds Transfer/Electronic Data Interchange (EFT/EDI), which 
enables employers to transmit child support income withholdings electronically.  All state child support agencies should be able to 
provide this service sometime in 1999. 
 
EFT electronically transfers dollars from one bank account to another.  EDI transfers information.  Employers can now use EFT/EDI to 
transfer child support payments and remittance information simultaneously to the centralized SDUs.  However, employers are not 
required to use EFT/EDI; it is optional. 
 
Benefits of EFT/EDI 
 
 Faster and more efficient than mailing paper checks and remittance information 
  
 Saves postage and administrative processing costs 
  
 Reduces the chances of errors like unidentified payments 
 
There is a specific format for EFT/EDI child support payments.  If you are interested in using EFT/EDI to submit income withholdings, 
contact the state child support agency to which you send income withholdings.                               

                                                            ‐33‐ 
 

Where May I Go for Help? 
 
For more information, contact your state child support enforcement office.  State child support office numbers are listed on the following 
panel. 
          Contact the OCSE Information Line for new hire reporting: (202)401-9267, 7:30 a.m.- 5:30 p.m. ET 
           
          Visit the OCSE web site: https://ocsp.acf.hhs.gov/csp/home/ocse (Many states have links to this web site). 
           
          New Hire Reporting - Stock No. 017-091-00249-5, $3.50/copy 
           
          The ABCs of Child Support Enforcement: Employer Overview -- Stock No. 017-091-00248-7, $4.75/copy 
           
          The Employer’s Desk Guide to Child Support -- Stock No. 017-091-00250-9, $23.00/copy 
 
To order, call GPO’S Superintendent of Documents at (202) 512-1800, Mon.-Fri., 7:30 a.m. to 5:00 p.m. ET, or visit the GPO web site 
at http://bookstore.gpo.gov.  There is a 25% discount on orders for more than 100 copies; the price includes shipping and handling. 
 
               State Child Support Enforcement Offices                                                        State Child Support Enforcement Offices 
       State       Main Office #                              Toll Free #                            State    Main Office #  Toll Free # 
 Alabama           (334)242-9300                                                               Montana        (406)442-7278 1/800/346-5437 1 
 Alaska            (907)269-6900                             1/800/478-3300 1                  Nebraska       (402)479-5555 1/800/831-4573 1 
 Arizona           (602)252-4045                                                               Nevada         (775)687-4744 1/800/992-0900 1 
 Arkansas          (501)682-8398                                                               New Hampshire  (603)271-4427 1/800/852-3345 1 
 California        (916)654-1532                             1/800/952-5253 1                  New Jersey     (609)588-2915  
 Colorado          (303)866-5994                                                               New Mexico     (505)827-7200 1/800/288-7207 1 
                                                                                                                            1/800-484-7631 2 
 Connecticut       (860)424-4989                             1/800/647-8872 2(information)     New York       (518)474-9081 1/800/343-8859 1 
 Delaware          (302)577-4800                             1/800/464-435 1                   North Carolina (919)571-4114 1/800/992-9457 2 
 Dist. of Columbia (202)724-1444                                                               North Dakota   (701)328-3582 1/800/231-4255 2 
 Florida           (850)488-4975                             1/800/622-5437 2                  Ohio           (614)752-6561 1/800/686-1556 1 
 Georgia           (404)657-3851                             1/800/227-7993 1                  Oklahoma       (405)522-5871 1/800/522-2922 2 
 Guam              (671)475-3360                                                               Oregon         (503)986-5950  
 Hawaii            (808)692-7000                             1/888/317-9081 2                  Pennsylvania   (717)787-3672 1/800/932-0211 2 
 Idaho             (208)334-5710                             1/800/356-9868 2                  Puerto Rico    (787)767-1500  
 Illinois          (217)524-4602                             1/800/447-4278 1                  Rhode Island   (401)222-2847 1/800/638-5437 1 
 Indiana           (317)233-5437                             1/800/622-4932 2                  South Carolina (803)898-9341 1/800/768-5858 2 
 Iowa              (515)281-5580                             1/888/229-9223 2                  South Dakota   (605)773-3641  
 Kansas            (785)296-3237                             1/800/432-0152                    Tennessee      (615)313-4880 1/800/838-6911 2 
 Kentucky          (502)564-2285                             1/800/248-1163 2                  Texas          (512)460-6000 1/800/252-8014 2 
 Louisiana         (225)352-4780                                                               Utah           (801)536-8500 1/800/257-9156 2 
 Maine             (207)287-2886                             1/800/371-3101 1                  Vermont        (802)241-2319 1/800/786-3214 2 
 Maryland          (410)767-7619                             1/800/332-6347 1                  Virgin Islands (340)775-3070  
 Massachusetts     (617)626-4000                             1/800/332-2733 2                  Virginia       (804)692-2458 1/800/468-8894 1 
 Michigan          (517)373-7570                                                               Washington     (360)664-5000 1/800/442-5437 2 
 Minnesota         (651)296-2542                                                               West Virginia  (304)558-3780 1/800/249-3778 2 
 Mississippi       (601)359-4861                             1/800/948-4010 2                  Wisconsin      (608)266-9909  
                                                             1/800/354-6039 1
 Missouri          (573)751-4301                             1/800/859-7999 2                  Wyoming        (307)777-6948  
 
1= In-State Only       2= Nationwide 
____________________________________________________________ 
Updated: 8/99 
  
                                                                                          ‐34‐ 
 

                                         INSTRUCTIONS 
    BUSINESS CHANGE AND AMENDMENT FORM (REG-C-L and REG-C-EA) 
                                                     
 I. GENERAL INSTRUCTIONS 
     
     A. Use the appropriate form for filing: 
         
        1.  Sole Proprietorships and Partnerships – may use Sections A - F of the REG-C-L (page 37)  to report changes 
            in tax/wage registration, and mail changes to the Division of Revenue and Enterprise Services (DORES), Client 
            Registration Bureau, PO Box 252, Trenton, NJ 08646-0252. 
 
        2.  Business Entities – i.e., Foreign or domestic corporations, limited partnerships, limited liability companies and 
            limited liability partnerships, may use Sections A –F of the Form REG-C-L (page 37) to report changes in address, 
            seasonal business cycles or tax/wage collection status only. Amendments     to articles recorded in the original 
            certificate of the  business entity, including  name changes, must be reported on the  REG-C-EA (page  38).  
            Business entities may submit Changes/Amendments through one of the service options listed in these instructions 
            (page 21) along with the correct Fee amount for filing an amendment (See Fee Schedule, page 22). 
 
        NJ authorized corporations  may not  use  the Business  Change/Amendment Form to  DISSOLVE, CANCEL, 
        WITHDRAW, MERGE OR CONSOLIDATE.  Contact the Division of Revenue at 609-292-9292 to obtain forms and 
        instructions for these transactions.  These forms may also be downloaded from the New Jersey Business Gateway 
        Service at www.nj.gov/treasury/revenue. 
         
        REMEMBER TO TYPE OR MACHINE PRINT ALL AMENDMENT FILING SUBMISSIONS. 
                                                     
     B. For Delivery/Return Options for Amended Business Filings, please see page 21, items 2a-2c. 
         
     C. Fee Schedule for Business Entity Amendment Filings 
         
        1.  Basic Filing Fees 
             a.      Filing fees for all corporate and Limited Partnership amendments is $75 per filing. 
                      
             b.      Filing fee for all Limited Liability Company and Limited Liability Partnership amendments is $100 per 
                     filing. 
     
             c.      Filing fee for corporate and Limited Partnership agent changes is $25 per filing. 
     
             d.      Filing fee for Limited Liability Company and Limited Liability Partnership agent changes is $25 per 
                     filing. 
 
        2.  Service Fees and Other Optional Fees (All added to basic fees above if selected, see page 21 Items 2a-2c for 
            service options) 
             
             a.      Expedited service per filing request  for corporations, non-profits  and LP transactions is  $15.00.  
                     Expedited service per filing for LLC and LLP transactions (8.5 business hour turnaround for over-the-
                     counter and FAX requests) is $25.00. 
                      
             b.      Same day service for FAX requests only, fee is $50.00 per filing. 
                      
             c.      Fax page transmission, fee is $1 per page for all filings that are FAXED back through the FAX filing 
                     service. 
                      
             d.      Certified copy fee for accepted filings is $25 per copy.                                 

                                                   ‐35‐ 
 

 II. LINE BY LINE REQUIREMENTS FOR BUSINESS AMENDMENT FILING (REG-C-EA) 
      A. Business Name and NJ 10-digit ID number - List the Business Entity name as currently reflected on the State’s 
         public records system and the NJ 10-digit ID number. 
          
      B. Statutory Authority for Amendment - In accordance with the following table, state the statutory authority for the 
         amendment.  Business entities seeking only to change registered office/agent may leave this blank. 
 
                 Business Entity Type           Amendment By:          Statutory Authority (NJSA 
                                                                       Title) to Enter in Field B 
            Domestic Profit Corps.               Incorporators         14A:9-1 et seq. 
            Domestic Non-Profit Corps.                                 15A:9-1 et seq. 
            Domestic Profit Corps.               Shareholders          14A:9-2(4) & 14A:9-4(3) 
            Domestic Non-Profit Corps.       Members or Trustees       15A:9-4 
            Foreign Profit Corps.            The Business Entity       14A:13-6 
            Foreign Non-Profit Corps.                                  15A:13-6 
            All Limited Liability Companies  The Business Entity       42:2B 
            All Limited Partnerships         The Business Entity       42:2A 
 
      C-E. Amendment Details - List the Article being amended and the type of certificate being amended. Recite the details 
          of the amendment, including a new name change if applicable.  Provide other provisions and an adoption date.  The 
          “Other Provisions” field may not be used to indicate the adoption of an Alternate Name (form C-150G) 
       
          If you are changing the corporate name, provide a designator that indicates the type of business entity, for example: 
          Inc., Corp., Corporation, Ltd., Co., or Company for a corporation; Limited Liability Company or L.L.C. for a Limited 
          Liability Company; Limited Partnership or L.P. for a Limited Partnership, Limited Liability Partnership or L.L.P. 
          for Limited Liability Partnership. 
       
         DORES will add an appropriate designator if none is provided. 
       
         ** Remember that the name must be distinguishable from other names on the State’s database.  DORES will check 
         the proposed name for availability as part of the filing process.  If desired, you can reserve/register a name prior to 
         submitting your filing.  To obtain information about reservation/registration services and fees, visit the Division's Web 
         site at www.nj.gov/treasury/revenue or call 609-292-9292 Monday – Friday, 8:30 a.m. – 4:30 p.m. 
 
      F. Certification of Consent/Voting - If applicable, pursuant to the statutes listed, provide the requested information on 
         consent/voting relative to the proposed amendment.  MARK THE METHOD of consent or voting employed to adopt 
         the amendment, and where applicable, provide the requested details associated with the chosen method. 
          
      G. Change of Agent/Office - If you are changing the registered agent or office or both, provide the following information 
         as applicable: 
 
         1. New Registered Agent - Enter one agent only - the agent may be an individual or a corporation duly registered 
            and in good standing with the State Treasurer; and/or 
             
         2. New Registered Office - Provide a New Jersey street address.  A Post Office Box may be used only if the street 
            address is listed as well. 
      
      H. Signatures for the Public  Record - If a corporate amendment is being  filed  by the incorporators, then the 
         incorporators and only the incorporators may sign.  For all other corporate amendments, the Chairman of the Board, 
         president or vice-president must sign.  For Limited Partnerships, at least one general partner must sign.  For all other 
         entities, an authorized partner or representative must sign. 
  
                                                ‐36‐ 
 

   REG-C-L                                                                                                                                                 Mail to:  
   (08-05)                                            STATE OF NEW JERSEY                                                                                            PO Box 252 
                            DIVISION OF REVENUE AND ENTERPRISE SERVICES                                                                                     Trenton, NJ 08646-0252 
                                                                                                                                                                      
                    REQUEST FOR CHANGE OF REGISTRATION INFORMATION                                                                                          No Fee Required 

Use this form to report any change in filing status, business activity, or to change your identification information such as identification number, business 
and/or trade name, business address, mailing address, etc.  DO NOT use this form for a change in ownership or an incorporation of a business.  A NJ-
REG must be completed for these changes. 
A. CURRENT INFORMATION (must be completed to process this form)                                                           
           FEIN:                                                                                                                                                             
         Name:    
        Address:   
B. CHANGES TO IDENTIFICATION INFORMATION 

        FEIN:                  -                                             Reason for change of FEIN:                             
        Business Name:       
                                                      (Corporations authorized by the NJ State Treasurer must file a corporate name change amendment, page 39) 
        Trade Name:                                                                                                                 
        Business Location: (Do not use P.O. Box for location address)                        Mailing Name and Address 
        Street                              Name:             
                                                          
        City                                                    State    Street:             
                                                                                                                                                                          
     Zip Code      -      City                                                                                                                                       State   
                                                                                                                                                                          
                                         (Give 9-digit Zip)                      Zip Code       -      
                                                                                                                           
C. Contact Information        Contact Person:                                                                            Title:              
                                                                                                                                              
           Daytime Phone:   (          ) _______-_____________                             E-mail address:                                             
    
D. IF SEASONAL, CIRCLE MONTHS BUSINESS WILL BE OPEN:                                                                                          
                JAN      FEB       MAR                APR       MAY       JUN                JUL       AUG      SEP                  OCT      NOV       DEC                    
E. CHANGES IN OWNERSHIP OR CORPORATE OFFICERS 
Name (Last Name, First, MI)                                                 Social Security Number                Home address (Street, City, State, Zip)              % 
Indicate new or resigning officer/owner and effective date of change                         Title                                                                     Ownership 
                                                                                                      
F. CHANGES IN FILING STATUS AND BUSINESS ACTIVITY                                                                                              
        Proprietorship/Partnership                              Date                                  Corporate Entities 
   ☐ Business Sold or Discontinued                                                                    Important: Corporate entities may not use this form to dissolve, 
                                                                                                      cancel, withdraw, merge, or consolidate.  Forms and Instructions for 
   ☐ Business Incorporated                                                                            these changes may be obtained online at www.nj.gov/treasury/revenue 
   ☐ Owner Deceased                                                                                   or by calling the Division of Revenue at 609-292-9292. 
   Name and Address of New Owner or Survivor of Merger                                                                               
                                                                                                                                     
   Date Ceased Collecting Sales Tax                                                          Date Ceased Renting Motor Vehicles                                        
   Date Ceased Paying Wages                                                                  Date Ceased Sale of New Tires/Motor Vehicles                              
   List any new State tax for which this business may be eligible: Tax                                                               Effective Date:                   
                                                                                           
Signature:                                                                 Date:
                                                                                                                                                           
Title:                                                                     Telephone:                (             )                -                      
                                                                                            
                                                                            ‐37‐ 
  

      REG-C-EA                                                                                                              Mail to:  
      (08-05)                                          STATE OF NEW JERSEY                                                                 PO Box 252 
                                 DIVISION OF REVENUE AND ENTERPRISE SERVICES                                                   Trenton, NJ 08646 
                                                                                                                                            
                                           BUSINESS ENTITY AMENDMENT FILING                                                    Fee Required 
Complete the following information and sign in the space provided.  Please note that once filed, the information on this page is considered public.  Refer 
to the instructions for delivery/return options, filing fees and field-by-field requirements.  Remember to remit the appropriate fee amount for this filing.  
Use attachments if more space is required for any field, or if you wish to add articles for the public record. 
                         
A.  Business Name: 
                                                                                                                                                     
        Business Entity NJ 10-digit Number   ____  ____  ____  ____  ____  ____  ____  ____  ____  ____ 
B.  Statutory Authority for Amendment                                                          (See Instructions for List of Statutory Authorities) 
                                                                                                
C.  Article                      OF THE CERTIFICATE of the above referenced business is amended to read as follows. 
    (If more space is  necessary, use attachment) 

D.  Other Provisions: (Optional)       
E.  Date Amendment was Adopted                                                                                   
F.  Certification of Consent/Voting: (If required by one of the following laws cited, certify consent/voting)   
    N.J.S.A. 14A:9-1 et seq. or N.J.S.A. 15A:9-1 et seq., Profit and Non-Profit Corps. Amendment by the Incorporators 
    ☐ Amendment was adopted by unanimous consent of the Incorporators. 
     
    N.J.S.A. 14A:9-2(4) and 14A:9-4(3), Profit Corps., Amendment by the Shareholders 
    ☐ Amendment was adopted by the Directors and thereafter adopted by the shareholders. 
      Number of shares outstanding at the time the amendment was adopted _________, and total number of shares entitled to vote 
      thereon _________.  If applicable, list the designation and number of each class/series of shares entitled to vote: 
       
      List votes for and against amendment, and if applicable, show the vote by designation and number of each class/series of shares 
      entitled to vote: 
                      Number of Shares Voting for Amendment                      Number of Shares Voting Against Amendment                   

      ** If the amendment provides for the exchange, reclassification, or cancellation of issued shares, attach a statement indicating the 
      manner in which same shall be effected. 
            
      N.J.S.A. 15A:9-4, Non-profit Corps., Amendment by Members or Trustees 
      The corporation      has ☐     does not have ☐ members. 
      If the corporation has members, indicate the number entitled to vote _________, and how voting was accomplished: 
 
       ☐ At a meeting of the corporation.  Indicate the number VOTING FOR ______ and VOTING AGAINST ______.  If any class(es) 
       of members may vote as a class, set forth the number of members in each class, the votes for and against by class, and the number 
       present at the meeting. 
                Class                  Number of Members                  Voting for Amendment                  Voting Against Amendment     

       ☐ Adoption was by unanimous written consent without a meeting. 
      If the corporation does not have members, indicate the total number of Trustees ________________, and how voting was accomplished: 
       ☐ At a meeting of the corporation.  The number of Trustees VOTING FOR __________ and VOTING AGAINST__________. 

       ☐ Adoption was by unanimous written consent without a meeting. 
G.  Agent/Office Change                                                                                                    
      New Registered Agent:                                                                                                 
     Registered Office: (Must be a NJ street address)                                                                      
     Street:                                                                City                                            Zip
                                                                                                                              
H.  Signature(s) for the Public Record (See Instructions for Information on Signature Requirements) 

Signature:                                                      Title                                            Date

Signature:                                                      Title                                            Date
                                                                           
      The above-signed certifies that the business entity has complied with all applicable NJ statutory filing requirements
                                                                      ‐38‐ 
   

 This page is left intentionally blank 

 ‐39‐ 
 

      CBT-2553                                                           State of New Jersey                                                                                      
        (08-05)                                                                                                                                                                                                                                    
                                                                         Division of Taxation 
                                                                                                                               
                                                         New Jersey S Corporation or  
                                 New Jersey Qualified Subchapter S Subsidiary (QSSS) Election 
Check  the appropriate box:  ☐ Initial S Corporation Election       New☐ Jersey QSSS Election (See instructions, #10)     Change☐                                   in S or QSSS Corporation Shareholders. 
IMPORTANT: This form only has to be filed once.  There is no renewal required.  Please Note:  All changes can be filed with the S corporation final return. 
Part I     Corporate Information         (Type or Print) 
Name of Corporation                                                                                                                 Federal Employer Identification Number 
                                                                                                                                                 -           
Mailing Address                                                                                                                     New Jersey Corporation Number 
                                                                                                                                                             -     -                                                                        
City or Town, State and Zip Code                                                                                                      Name and telephone number of corporate officer or legal representative
                                                                                                                                                                                                           (           )               - 
                                                                                                                                    Date of Incorporation                    State of Incorporation 
Check here  ☐ if the corporation has changed its name or address in the past 12 months                                                               /            /           
           Election Information 
Enter the effective date of the Federal S corporation or QSSS election _____ / _____ / _____                             Applied for   ☐
                                                                                                    month     day        year 
New Jersey S corporation or New Jersey QSSS election is to be effective for tax year beginning _____ / _____ / _____  ending _____ / _____ / _____ 
                                                                                                                                                              month     day        year               month     day       year 
NOTE:      If this election takes effect for the first tax year the corporation exists, enter for item 2 and item 3, the month, day and year of the earliest of the following: 
           (1) date the corporation first had shareholders, (2) date the corporation first had assets, or (3) date the corporation began doing business.  If the accounting 
           period you enter is for an automatic 52-53 week tax year, check here ☐     
Part II    Shareholder’s Consent Statement - By signing this election, we the undersigned shareholders, consent (1) to the corporation’s election to be treated as a 
           New Jersey S corporation under N.J.S.A. 54:10A-1, et seq., (2) that New Jersey shall have the right and jurisdiction to tax and collect the tax on each 
           shareholder’s S corporation income, as defined in N.J.S.A. 54A:5-10 and (3) such right and jurisdiction shall not be affected by a change of a shareholder’s 
           residency, except as provided in N.J.S.A. 54A:1-1, et seq.  Shareholders must sign, date and provide the requested information below.  For the original or 
           initial election to be valid, the consent of each shareholder, person having a community property interest in the corporation’s stock, and each tenant in 
           common, joint tenant, and tenant by the entirety must appear below or be attached to this form.  If more space is needed, a continuation sheet reporting the 
           exact information for additional shareholders or a second consent statement must be attached to this form. 
Name of each  shareholder, person having a               *** Signatures must be provided ***                                                         Stock Owned             Social Security Number or                                   *Share-
community property interest in the  corporation’s                                                                                                                            Employer Identification                                     holder’s 
stock, and each tenant in common, joint tenant, and                 Signature                                                  Date            Number               Dates    Number for an estate or                                     state of 
tenant by the entirety.  (A husband and wife (and                                                                                              of shares            acquired  qualified trust                                            residency 
their estates) are counted as one shareholder). 
                                                                                                                                                                                                                                          
*You must provide the address of any shareholder who is not a resident of New Jersey on a rider and attach it to this form 
Part III   Corporation’s Consent Statement - The above named corporation consents (1) to the election to be treated as a New Jersey S corporation under 
           N.J.S.A. 54:10A-1, et seq., (2) to fulfill any tax obligations of any nonconsenting shareholder who was not an initial shareholder as required by any tax law in 
           the State of New Jersey including the payment of tax to the State of New Jersey on behalf of such shareholder.  (An authorized officer must sign and date 
           below.) 
Under penalties of perjury, I declare that I have examined this election, including accompanying schedules and statements, and to the best of my knowledge and belief, it is 
true, correct, and complete. 
X                                                                                                                                                                     
                 Signature of Authorized Officer                                                                               Title                                              Date
Part IV    Persons who are no longer shareholders of the corporation                                                                                     Do not enter any shareholder who sold or transferred all 
                                                                                                                                                         of his or her stock before the election was made 
Name of shareholder, person no longer having a community property                                                                                                            Social Security Number 
interest in the corporation’s stock, tenant in common, joint tenant, or                                                        Date                                               or 
tenant by the entirety.  (A husband and wife (and their estates) are                                                           Stock Relinquished                   Employer Identification Number for an estate 
counted as one shareholder).                                                                                                                                                     or qualified trust 
                                                                                                                               /             /                                   /             / 
                                                                                                                               /             /                                   /             / 
                                                                                                                               /             /                                   /             / 
                                                                                                                               /             /                                   /             / 
Under penalties of perjury, I declare that the above, to the best of my knowledge and belief, is true, correct, and complete. 
                                                                                                                                                                      
                 Signature of Authorized Officer                                                                               Title                                              Date
                                                                                     ‐40‐ 
  

Part V  Qualified Subchapter S Subsidiary Election 
        Corporation’s Consent Statement -  The  above named corporation consents (1) to the election to be treated as a “New Jersey  Qualified  Subchapter 
        S Subsidiary” and (2) to file a CBT-100S reflecting the $500 minimum tax liability or the $2,000 minimum tax liability if the taxpayer is a  member of an 
        affiliated group or a controlled group whose group has a total payroll of $5,000,000 or more for the privilege period.   (An authorized officer must sign and 
        date below.) 
Under penalties of perjury, I declare that I have examined this election, and to the best of my knowledge and belief, it is true, correct, and complete. 
                                                                                                                 
        Signature of Authorized Officer                                               Title                                                             Date
                             
       Corporate Parent Company’s Consent Statement - By signing this election, the undersigned corporation consents (1) to the subsidiary’s election to be treated 
       as a “New Jersey Qualified Subchapter S Subsidiary” and (2) to taxation by New Jersey by filing a CBT-100S or a CBT-100 and remitting the appropriate tax 
       liability including the assets, liabilities, income, and expenses of its QSSS. 
        
        Corporate Parent Name                                                         Address                               FID Number 
                                                                                        
Under penalties of perjury, I declare that I have examined this election, and to the best of my knowledge and belief, it is true, correct, and complete. 
                                                                                                                 
        Signature of Authorized Officer                   Title                                                                                         Date
  
                                                      Instructions for Form CBT-2553 
  
                                                                                             would otherwise  apply.   To revoke an election,  a  letter of 
  1.    Purpose - A corporation must file form CBT-2553 to elect to be                       revocation signed by shareholders holding more than 50% of the 
        treated as a New Jersey S corporation or a New Jersey QSSS or                        outstanding shares of stock on the day of revocation should be 
        to report a change in shareholders.  Check the appropriate box to                    mailed to the address in instruction 3 on or before the last day of 
        indicate if this is an initial S corporation election or a change in                 the first tax year to which the election would otherwise apply.  A 
        S or QSSS corporation shareholders or a New Jersey QSSS                              copy of  the original  election  should accompany  the letter of 
        election.                                                                            revocation.  Such a revocation will render the original election 
  2.    Who may elect - A corporation may make the election to be                            null and void from inception. 
        treated as a New Jersey S corporation only if it meets all of the             7.     Initial election - Complete Parts I, II and III in their entirety for 
        following criteria:                                                                  an initial New Jersey S Corporation election.  Each shareholder 
        a)        The corporation is or will be an S corporation pursuant                    who owns (or is deemed to own) stock at the time the election is 
                  to section 1361 of the Federal Internal Revenue Code;                      made, must consent to the election.  A list providing the social 
                                                                                             security number and the address of any shareholder who is not a 
        b)        Each shareholder of the corporation consents to the                        New Jersey resident must be attached when filing this form. 
                  election and the jurisdictional requirements as detailed 
                  in Part II of this form;                                            8.     Reporting shareholders who were not initial shareholders - 
                                                                                             Complete Parts I, II and III when filing this form to report any 
        c)        The corporation consents to  the  election  and the                        new shareholder.  A new shareholder is a shareholder who, prior 
                  assumption of any tax liabilities of any nonconsenting                     to the acquisition of stock, did not own any shares of stock in the 
                  shareholder who was not  an  initial shareholder  as                       S corporation, but who acquired stock (either existing shares or 
                  indicated in Part III of this form.                                        shares issued at a later date) subsequent to the initial New Jersey 
  3.    Where to file - Mail form CBT-2553 to: New Jersey Division of                        S corporation election.   If a new shareholder fails to sign a 
        Revenue and Enterprise Services (DORES), PO Box 252,                                 consent statement, the corporation is obligated to fulfill the tax 
        Trenton, NJ 08646-0252.                                                              requirements as stated in Part III on behalf of the nonconsenting 
                                                                                             shareholder.  An existing shareholder whose percentage of stock 
  4.    When to make the election - The completed form CBT-2553                              ownership changes is not considered a new shareholder.  If the 
        shall be filed within one calendar month of the time at which a                      taxpayer previously had elected to be treated as a New Jersey 
        Federal S corporation election would be required.  Specifically,                     QSSS, the new shareholder must also complete Part V. 
        it must be filed at any time before the 16th day of the fourth 
        month of the first tax year the election is to take effect (if the tax        9.     Part IV should only be completed for any person who is no 
        year has 3-1/2 months or less, and the election is made not later                    longer a shareholder of the corporation.  You do not have to enter 
        than 3 months and 15 days after the first day of the tax year, it                    any shareholder who sold or transferred all of his or her stock 
        shall be treated as timely made during such year).  An election                      before the election was made.  All changes can be filed with the 
        made by a small business corporation after the fifteenth day of                      S corporation final return. 
        the fourth month but before the end of the tax year is treated as             10.    Part V must be completed in order to permit a New Jersey S 
        made for the next year.                                                              Corporation to be treated as a New Jersey Qualified Subchapter 
  5.    Acceptance or non-acceptance of  election – DORES will                               S Subsidiary and remit only a minimum tax.  Complete parts I 
        notify you if your election is accepted or not accepted within 30                    and II, in  addition to Part V. The parent company  also must 
        days after the filing of the CBT-2553 form. If you do not receive                    consent to filing and remitting New Jersey Corporation Business 
        a notice within 30 days, you may call DORES Customer Service                         Tax which would include the  assets, liabilities, income  and 
        Center at (609)292-9292.                                                             expenses of its QSSS along with its own.  Failure of the parent 
                                                                                             either to consent or file a CBT-100 or CBT-100S for a period 
  6.    End of election -   Generally,  once an  election is made, a                         will result in the disallowance of the New Jersey QSSS election 
        corporation remains a New Jersey S corporation as long as it is                      and require the subsidiary  to  file and remit  a CBT-100S 
        a Federal S corporation.  There is a limited opportunity to revoke                   determining its own liability. 
        an election only during the first tax year to which an election 

                                                        ‐41‐ 
  

                             Instructions for Form CBT-2553 – Cert 
                                                        
 1. This form is to be used by non-New Jersey business entities wishing to apply for New Jersey "S" 
    Corporation status which are not required to be authorized to transact business in accordance with N.J.S.A. 
    14A:13-3, given below.  This form is in addition to and must accompany form CBT-2553. 
     
 2. Name of Corporation: Type or print name exactly as it appears on form NJ-REG and the CBT-2553. 
     
 3. Federal Employer Identification Number (FEIN): Please enter the Federal Identification Number assigned 
    by the Internal Revenue Service. 
 
 4. Please read the Corporate Attestation and the cited statutes for compliance. 
 
 5. Print the name and title of the corporate officer signing this document and the CBT-2553.  Both documents 
    must be signed by the same corporate officer. 
 
 6. Mail the completed forms to: New Jersey Division of Revenue, PO Box 252, Trenton, NJ 08646-0252. 
 
14A:13-3. Admission of foreign corporation 
 
 1) No foreign corporation shall have the right to transact business in this State until it shall have procured a 
    certificate of authority to do business from the Secretary of State.  A foreign corporation may be authorized 
    to do business which may be done lawfully in this State by a domestic corporation, to the extent that it is 
    authorized to do such business in the jurisdiction of its incorporation, but no other business. 
     
 2) Without excluding other activities which may not constitute transacting business in this State, a foreign 
    corporation shall not be considered to be transacting business in this State, for the purposes of this act, by 
    reason of carrying on in this State any one or more of the following activities:  
 
    (a) maintaining, defending  or otherwise participating in any action or proceeding, whether judicial, 
        administrative, arbitrative or otherwise, or effecting the settlement thereof or the settlement of claims 
        or disputes; 
    (b) holding meetings of its directors or shareholders;   
    (c) maintaining bank accounts or borrowing money, with or without security, even if such borrowings are 
        repeated and continuous transactions and even if such security has a situs in this State; 
    (d) maintaining offices or  agencies for the transfer,  exchange and registration of its securities,  or 
        appointing and maintaining trustees or depositaries with relation to its securities. 
 
 3) The specification in subsection 14A:13-3(2) does not establish a standard for activities which  may 
    subject a foreign corporation to service of process or taxation in this State. 
     
                                                      ‐42‐ 
 

 CBT-2553  – Cert                                                  Mail to: 
  (8-05)                                                           PO Box 252 
                                                                   Trenton, NJ 08646-0252 
                                                                        609-292-9292 
                                     State of New Jersey 

                                     Division of Taxation 

                         New Jersey S Corporation Certification 

 This certification is for use by unauthorized foreign (non-NJ) entities that want New Jersey S 
 Corporation Status.  This form MUST be attached to form CBT-2553. 

 Part I. Corporate Information (Type or Print) 

 Name of Corporation:                                                                 

 Federal Employer Identification Number:        -                                     

 Part II. Corporate Attestation 

 By signing this statement, the corporation affirms that the corporation has not conducted any activities 
 within this state that would require the Corporation to file a Certificate of Authority in accordance with 
 N.J.S.A.  14A:13-3.    Specifically, the corporation  attests that it is not transacting business  in 
 accordance with the definitions provided in statute. 

 Print the name and title of the person executing this document on behalf of the Corporation.  This 
 person must be a corporate officer. 

  Name:                                               Title:

  Signature:                                          Date:
  
                                               ‐43‐ 
 

                                                                                                     Send completed application to: 
                                      STATE OF NEW  ERSEYJ                                            
                                                                                                       Division of Revenue and Enterprise 
                       DIVISION OF REVENUE AND             NTERPRISE E            ERVICESS                                                            Services 
                                  CM-100 Cigarette License Application                                                 PO Box 252 
                                            Retail Over-the-Counter                                             Trenton, NJ 08646-0252 
                                             Vending Machine                                                                                           
                                  Manufacturer Representative License                                  ENCLOSE FEE WITH APPLICATION 
  Cigarette License Type (period April 1, _______ – March 31, _______)                                 License Fee                                             Amount Due 
  
     Cigarette Retail Dealer(s) Over-the-Counter License  
                                                                                                       $50.00 
 ☐   Complete sections A & B below                                                                                                                        $ 
  
     Cigarette Vending Machine License  
                                                                                                     $50.00 per machine 
 ☐     Complete sections A & C  below                                                                                                                     $ 
  
     Cigarette Manufacturer Representative License 
                                                                                                   $5.00 per representative 
 ☐     Complete sections A & D below                                                                                                                      $ 
 Section A – Licensee Information 
  Taxpayer Name/Business Name                                                                          Start date for business in New Jersey
                                                                                                                      /                                   /          
 Trade  Name                  New Jersey Tax Identification    Number             Social Security Number    (individuals)    
                                             -     -       /                                                           -        -                                    
 Business   Address                                                                       Mailing Address                                           ☐ Same    as Business    Address 
                                                                                                                                                                       
           Business Type                                                                               All Corporation’s, LLC’s and LLP’s 
  (check appropriate     box) ☐Corporation      ☐LLC  ☐     LLP  ☐Partnership    ☐Sole Proprietorship       enter the State    of Incorporation        
  Contact Name:                                                                   Phone           Number:    -                                               -        

  E-Mail Address:                                                                                                                                                      
                                             OWNERS’ INFORMATION (attach list if needed)
 Name                                                                           Home Address
                                                                                                                                                               
 Social Security Number                      Title                                                                                                             
              -         -                                                                                                                                              
 Section B – Retail Over-the-Counter License (provide information about those from whom you purchase cigarettes – attach list if needed) 
 Supplier(s) Name                                                               Supplier(s) Address
                                                                                                                                                               
 Supplier Phone Number
              -           -                                                                                                                                            
 Section C – Vending Machine License (provide information about the machines you will operate – attach list if needed) 
 Supplier(s) Name                                                               Address where machine is located 
                                                                                                                                                               
 Supplier(s) Phone Number
              -           -                                                                                                                                            
 Section D – Manufacturer Representative License (provide information about the company you represent – attach list if needed)
 Company(s) Name                                                                Supplier(s) Address
                                                                                                                                                               
 New Jersey Tax Identification Number
              -           -       /                                                                                                                                    
                                                                                                                                                              
 Enter the total fee below for the license(s) you are requesting. Then sign 
 the application and print your name, title and today's date. By signing you                                                                                  
 affirm that all information is complete and accurate. Mail this application 
 together with a payment for the total fee amount below. Please make your       Authorized Signature                                                             Date
 check or money order payable to “Treasurer, State of NJ.”                                                                                                                
                                                                                 
   Total Fee Enclosed:  $ 
                                                                                Print Name                                                                       Title
                                                                               
                                                                             ‐44‐ 
 

                                     New Jersey Form MFA-1 Instructions 
 
    Complete all appropriate sections and remit this             owner of the company, a completed Form M-5008-R must 
application with a check for the total application fee           accompany this application. 
payable to “State of New Jersey – LMF” to:                        
    New Jersey Division of Taxation                              The Individual Completing this form is the individual who 
    P. O. Box 189                                                actually provides the information on the application.  If 
    Trenton, NJ 08695-0189                                       this individual is not an employee or owner of the 
                                                                 company, a completed Form M-5008-R must accompany 
    Be sure to check whether this is an Initial, Change, or      this application. 
Renewal Application.  If you are a licensee and wish to           
note changes of Address, Activity, etc, check Change.            Section 3 – Prior Owner Information 
                                                                 This section is for individuals or companies who purchase 
    Failure to provide all required data will result in          an existing business.  All others should enter “N/A” under 
    automatic denial of this application.                        Former Business Name  and leave all other spaces in 
                                                                 Section 3 blank. 
 
Section 1 – Business Information 
                                                                 Section 4 – Type of Ownership 
If you already have a NJ Tax Identification Number, enter 
                                                                 Check the box that applies and leave all others blank.  If 
it, otherwise leave that space blank. 
                                                                 you check New Jersey Corporation,  you must give the 
 
                                                                 Date of Incorporation.  If you check Out of State 
If  you already have an IRS 637  Number, enter it; 
                                                                 Corporation, you must give the state of incorporation and 
otherwise leave that space blank. 
                                                                 the Date Registered in New Jersey.  If you check “Other” 
 
                                                                 you must give the type of ownership. 
The Business Name is your company’s name as it appears 
                                                                  
on the Business Registration. 
                                                                 Section 5 – Owner Information 
 
                                                                 You must provide all requested information for the owner, 
The Trade Name is the name by which your company does 
                                                                 owner and spouse, all partners, or all principal officers.  If 
business and is known in the industry. 
                                                                 there are more than four partners or principal officers, you 
 
                                                                 must write “See Rider Attached” in the first space and 
The Physical Address is your company’s primary location 
                                                                 provide the information on a separate sheet. 
for operations in New Jersey.  If there are no New Jersey 
                                                                  
locations, enter your company’s primary business location. 
                                                                 Section 6 – Relationships with other Organizations 
 
                                                                 Provide this information for any  owner, officer, or 
The Mailing Address is the address the Division of 
                                                                 employee who operated, managed, or reported for another 
Taxation can use to contact your company for  general 
                                                                 company that required a Motor Fuels license of any type. 
inquiries or notices. 
                                                                  
                                                                 Section 7 – Type of Products Handled 
The Books and Records Address is the address the 
                                                                 Check each type of product you will possibly handle in 
Division of  Taxation can use to contact your company 
                                                                 New Jersey.  If you check “Other” you must give each 
regarding reporting and payments.  It is the address where 
                                                                 other product. 
tax specific inquiries will be sent. 
                                                                  
                                                                 Section 8 – Business Activity; License Requested 
Section 2 – Contact Information 
                                                                 Check one or more of the license types highlighted.  For 
The Contact  for Registration is the individual who  can 
                                                                 each license you request, you must be able to check one or 
answer questions regarding this application.  If this 
                                                                 more of the numbered boxes below that license type.  You 
individual is not an employee or owner of the company, a 
                                                                 must pay the application fee for each license requested.  
completed Form M-5008-R must accompany this 
                                                                 Enter the total amount due for all licenses requested at the 
application. 
                                                                 end of this section.  You may write one check for the total 
 
                                                                 due for all licenses requested.  Make the check payable to 
The Contact for Reporting is the individual who can 
                                                                 State of New Jersey – LMF. 
answer questions regarding filing of reports and issuance 
                                                                  
of payments.  If this individual  is not an employee or 
                                                                  
                                                            ‐45‐ 
 

                                                                  Terminal Operators – Provide the requested information 
Section 9 – Consumer Registration                                 for the New Jersey terminal(s) you operate. 
Complete this section if you are an end user who picks up          
fuel in a terminal or if you receive, produce, or blend fuel      Section 13 – New Jersey Storage Tank Information 
that has not been taxed.                                          Please  furnish the requested information for all storage 
                                                                  tanks you have in New Jersey.  It is not necessary to list 
Section 10 – Fuel  Customers/Suppliers/Position                   individual tanks.  Show the total storage capacity for each 
Holders                                                           product type for each location.  If you have no storage in 
Provide the information requested for the companies with          New Jersey, write “N/A” in the first space. 
whom you do business.   If  you deal in more than  one             
product with a particular company, list it once for each          Section 14 – Bond Information 
type of product.  Under “How product is received” state           Complete the sections appropriate for the type of license 
how your company receives control or possession of the            you are requesting.  If you are requesting more than one 
products listed.  For instance, pipeline, rack, rail, barge,      license, you will need a separate bond for each license. 
etc.                                                               
                                                                  Section 15 – Notice of Election for Suppliers and 
Section 11 – Transporters Hired                                   Permissive Suppliers 
Provide the  information requested for each transporter           This section is for Suppliers and Permissive Suppliers 
hired by your company.  If you use your own modes of              only.  Suppliers may complete this section if they choose.  
transport, write “Own  means of transport” in the  first          Their choice will not affect the rest  of the application.  
space, and apply for a Transporters License.  If you neither      Permissive Suppliers must complete this section, or  the 
provide modes of transport nor  hire transporters, write          application will be denied.  Other applicants should write 
“N/A” in the first space.                                         “N/A” in the signature space. 
                                                                   
Section 12 - Terminals                                            Section 16 – Application to be a Qualified Distributor 
Suppliers – Provide the requested information for New             This section is to be completed by Distributor applicants 
Jersey terminals in which you are a position holder and any       who desire recognition as a Qualified  Distributor.   All 
out-of-state terminals in which you are a position holder         others should write, “N/A” in the signature space.  A 
and will collect the New Jersey tax on all removals               Distributor applicant’s choice not to apply for recognition 
destined to New Jersey.                                           as a Qualified Distributor will not affect the rest of this 
                                                                  application. 
Permissive Suppliers – Provide the requested information           
for any out-of-state terminal in which you are a position         Section 17 – Authorizing Signature 
holder and agree to precollect the New Jersey tax on all          Only an individual listed in Section 5 of this application 
removals destined for New Jersey.                                 may sign this application.  Without an appropriate 
                                                                  signature, this application cannot be processed. 
                                                                   
                                                             ‐46‐ 
 

                                           Motor Fuel License Types 
                                                                   
"Blender" means a person that produces blended motor fuel outside the terminal transfer system. 
 
"Distributor" means a person who acquires motor fuel from a supplier, permissive supplier or from another distributor for 
subsequent sale. 
 
"Exporter" means any person, other than a supplier, who purchases fuel in this State for the purpose of transporting or 
delivering the fuel outside of this State. 
 
"Importer" includes any person who is the importer of record, pursuant to federal customs law, with respect to fuel.  If the 
importer of record is acting as an agent, the person for whom the agent is acting is the importer.  If there is no importer of 
record of fuel imported into this State, the owner of the fuel at the time it is brought into this State from another state or 
foreign country is the importer. 
 
"Liquefied petroleum gas dealer" means a person who acquires liquefied petroleum gas for subsequent sale to a consumer 
and delivery into the vehicle fuel supply tank. 
 
"Permissive supplier" means an out-of-State supplier that elects, but is not required, to have a supplier's license pursuant to 
P.L.2010, c.22 (C.54:39-101 et al.). 
 
"Retail dealer" means a person that engages in the business of selling or dispensing motor fuel to the consumer within this 
State. 
 
"Supplier" means a person that is: 
 a. registered or required to be registered pursuant to section 4101 of the federal Internal Revenue Code of 1986 (26 
       U.S.C. s.4101) for transactions in fuels in the terminal transfer system; and 
 b. satisfies one or more of the following: 
       (1)    is the position holder in a terminal or refinery in this State; 
       (2)    imports fuel into this State from a foreign country; 
       (3)    acquires fuel from a terminal or refinery in this State from a position holder pursuant to either a two-party 
              exchange or a qualified buy-sell arrangement which is treated as an exchange and appears on the records 
              of the terminal operator; or 
       (4)    is the position holder in a terminal or refinery outside this State with respect to fuel which that person 
              imports into this State.  A terminal operator shall not be considered a supplier based solely on the fact that 
              the terminal operator handles fuel consigned to it within a terminal. 
 
"Supplier" also means a person that produces fuel grade alcohol or alcohol-derivative substances in this State, produces fuel 
grade alcohol or alcohol-derivative substances for import to this State into a terminal, or acquires upon import by truck, rail 
car or barge into a terminal, fuel grade alcohol or alcohol-derivative substances. 
 
"Supplier" includes a permissive supplier unless the "Motor Fuel Tax Act" P.L.2010, c.22 (C.54:39-101 et seq.) specifically 
provides otherwise. 
 
"Terminal operator" means a person that owns, operates, or otherwise controls a terminal.  A terminal operator may own 
the fuel that is transferred through, or stored in, the terminal. 
 
"Transporter" means an operator of a pipeline, barge, railroad or fuel transportation vehicle engaged in the business of 
transporting fuel. 
 
"Ultimate vendor - blocked pumps" means a person that sells clear kerosene at a retail site through a blocked pump and who 
is registered with both the Division of Taxation in the Department of the Treasury and the federal Internal Revenue Service 
as an ultimate vendor - blocked pumps.  

                                                        ‐47‐ 
 

 State of New Jersey 

 Form MFA-1 

 Motor Fuels Application & Instructions 

 ‐48‐ 
 

 Division use only – DLN Stamp                                                                                                                                    Division use only – Date Stamp 

                                 State of New Jersey 
                                 Send to:                                                                                                                             Rev 12-2013 

                                 New Jersey Division of Taxation 
                                 PO Box 189 
                                 Trenton,          NJ 08695-0189 
                                                                                                                                                                                           
                                                                                Combined Motor Fuels 
                                 Form MFA – 1                                                      License Application                                                                     
                                                                                                                                                                                           
  ☐ Initial Application                                                   ☐ Change Application                                                             ☐ Renewal Application 

 Section 1 – Business Information 
 Federal ID Number               IRS 637 Number                            New Jersey Tax ID Number                                           Does your company have ☐ Yes 
                                                                                                                                              internet access?       ☐ No 
 Business Name                                                                                                                                Webpage Address 

 Trade Name                                                                                                                                   Phone Number           Fax Number 

 Physical Address 

 Mailing Address 

 Books and Records Address 

 Hours of Operations 
 ☐ Mon.         -        ☐ Tues.        -         ☐ Wed.         -        ☐ Thur.       -          ☐ Fri.         -                           ☐ Sat.         -          ☐ Sun.         -          
  
 Section 2 – Contact Information 
 If you wish to give an attorney, or accountant access to your tax information, you must supply us with an Appointment of Taxpayer 
 Representative Form (Form M-5008-R) giving us the authority to release confidential information to them. 
 Contact for Registration                             Title                 Telephone No                                                      Email Address 

 Contact for Reporting                                Title                 Telephone No                                                      Email Address 

 Individual Completing this form                      Title                 Telephone No                                                      Email Address 

 Section 3 – Prior Owner Information 
 Complete if you are purchasing an existing business 
 Former Business Name                                                           Former License Number                                                          Former Phone Number 

 Former Business Address                                                                                                     City, State, Zip                  Date Ownership Transferred 

 Former Business Mailing Address                                                                                        City, State, Zip                       Date Former Business Ended 

                                                                           ‐49‐ 
 

 Section 4 – Type of Ownership 
 ☐ Sole Proprietorship (may include spouse)     ☐ Partnership                                                                                       ☐ Limited Partnership 
 ☐ Limited Liability Partnership                ☐ Government Entity                                                                                 ☐ Trust 
 ☐ New Jersey Corporation                       ☐ Out of State Corporation – State:  ______                                                         ☐ Other (specify) 
 Date of Incorporation: ______________          Date Registered in New Jersey:         ______                                                            _________________________ 
                                                                                                                                                     
 Section 5 – Owner Information 
 Provide information for Sole Proprietor, all Partners, or Principal Officers of Corporations or Limited Liability Corporations 
 (attach rider if necessary). 
 Name (Last, First, M)                                                   Title                                                                                        Social Security Number

 Home Address                                                            Home Phone Number                                                                            Cell Phone Number 

 Name (Last, First, M)                                                   Title                                                                                        Social Security Number

 Home Address                                                            Home Phone Number                                                                            Cell Phone Number 

 Name (Last, First, M)                                                   Title                                                                                        Social Security Number

 Home Address                                                            Home Phone Number                                                                            Cell Phone Number 

 Name (Last, First, M)                                                   Title                                                                                        Social Security Number

 Section 6 – Relationship with Other Organizations 
 Information regarding persons affiliated with this business who either are also affiliated or have been affiliated with another 
 business  that requires licensing under NJSA §54:39-101 et seq (attach rider if necessary) 
 Name (Last, First, M)                                              Title with Applicant                                                            Date joining Application Social Security Number 

 Name (Last, First, M)                                              Title with Applicant                                                            Date joining Application Social Security Number 

 Individual’s Home Address                                                                                                         City, State, Zip 

 Name of Business with which Affiliation Exists                     Affiliated Business FID                                                         Title                    Effective Date of Title 

 Name (Last, First, M)                                              Title with Applicant                                                            Date joining Application Social Security Number 

 Name (Last, First, M)                                              Title with Applicant                                                            Date joining Application Social Security Number 

 Individual’s Home Address                                                                                                         City, State, Zip 

 Name of Business with which Affiliation Exists                     Affiliated Business FID                                                         Title                    Effective Date of Title 

 Section 7 – Types of Products Handled 
 Check each type of product with which you will be dealing in New Jersey 
 ☐ Gasoline                      ☐ LPG                              ☐ Dyed Kerosene                                                                         ☐ Undyed Kerosene 
 ☐ Gasohol                       ☐ Undyed Diesel                    ☐ Undyed Biodiesel                                                                      ☐ Aviation Fuel 
 ☐ Fuel Grade Alcohol            ☐ Dyed Diesel                      ☐ Dyed Biodiesel                                                                         
 ☐ Other – List each other                                           
      product:                                                                                                                                               

                                                              ‐50‐ 
 

 Section 8 – Business Activity; License Requested 
 Check all that apply 

 ☐ Supplier of Motor Fuels                                                                                                                               
                                                                                  An Application Fee of $450 is due for a 3-year license.
  1. ☐ You are registered or required to be registered pursuant to Section 4101 of the Federal Internal Revenue Code of 1986 and one or more of A through E 
  
      A. ☐ You are a Position Holder in a terminal in New Jersey (List each Terminal and its location) 

      B. ☐ You export fuel from this State (List the states to which you export and your License No in each state) 

      C. ☐ You Import as a Position Holder in another state (List the states from which you import and your License No in each state) 

      D. ☐ You Import from another Position Holder (List the Position Holders, the Position Holder’s License No, and the state) 

      E. ☐ You acquire Motor Fuel in this State by two-party exchanges (List exchange partners and their License N )o  

  2. ☐ You produce Fuel Grade Alcohols in New Jersey or for import into New Jersey 
  
 ☐ Permissive Supplier of Motor Fuels                                                                                                                    
                                                                                  An Application Fee of $450 is due for a 3-year license.
   ☐ You are an out of State Supplier who is not required to be licensed as a Supplier in this State, but you elect to be licensed anyway 
  
                                                                                  An Application Fee of $450 is due for a 3-year license for  each 
 ☐ Terminal Operator 
                                                                                  Terminal Operated. 
  1. ☐ You own one or more Terminals in New Jersey (List each Terminal, state whether it is a barge, pipeline, or fixed location, and its location) 

  2. ☐ You control one or more Terminals in New Jersey (List each Terminal, state whether it is a barge, pipeline, or fixed location, and its location) 

  3. ☐ You commingle products with those of another company (List each company and the products commingled) 

 ☐ Distributor of Motor Fuels                                                     An Application Fee of $450 is due for a 3-year license. 
   1. ☐ You acquire Fuel from a Supplier, Permissive Supplier, or another Distributor for subsequent resale 
  2. ☐ You import Fuel from another state (List the states, Suppliers, each Supplier’s License No and the products imported) 

  3. ☐ You export Fuel to another state (List the states, customers, each customer’s License No, and the products exported) 

  4. ☐ You blend Fuels (List the types of fuels you blend and the blend stocks used) 

  5. ☐ You sell Aviation Fuels 

                                                                             ‐51‐ 
 

                                                                                  An Application Fee of $150 is due for a 3-year license. 
 ☐ Retailer of Motor Fuels 
                                                                                  You must file a separate MFA-1 for each retail establishment. 
  1. ☐ You engage in the business of selling or dispensing motor fuel to the consumers in this state. 

  2. ☐ You operate a blocked pump for clear kerosene. 

  3. ☐ You sell Aviation Fuels to the consumers. 

  4. ☐ You dispense LPG into on-road vehicles. 

  Please provide the following regarding your retail location. 
  1. What is the baseload minimum power requirement for your station?       (ensuring back up power to pumps, P.O.S system, lighting, and requisite safety equipment)

  2. Do you have a backup generator on site?     Yes     ☐ No☐  

  3. If yes, please submit a description. 

  4. If no, is your station pre-wired for a generator? 

  5. Number of gasoline pumps. ______________                     Average gallons of gasoline sold during the last 12 months. ______________   

  6. Number of diesel pumps. ______________                       Average gallons of diesel fuel sold during the last 12 months. ______________   

  7. Number of kerosene pumps. ______________                     Average gallons of kerosene sold during the last 12 months. ______________   

  8. Do you lease your location (if yes, please provide a copy of the lease agreement)?       Yes     ☐ No☐
                                                                                  An Application Fee of $50 is due for a 1-year license for each 
 ☐ Transporter 
                                                                                  conveyance licensed. 
  1. ☐ You transport your own fuels. 
  2. ☐ You transport fuels under contract as a common carrier.List(   your customers, each customer’s License No, and the fuels transported) 

     For each Fuel Transportation Vehicle of Vessel, give the following information. (Attach rider if you are licensing more than 14 vehicles or vessels.) 
                Conveyance Type                        VIN or Vessel Name                        Conveyance Type                          VIN or Vessel Name 
                                                                                               
 Total Application Fee due for this application: $____________ 

 Section 9 – Consumer Registration 
 Only Consumers may complete this section.    If you sell fuel, then you are not a Consumer and you must apply for one of the licenses in 
 Section 8. 
                ☐ You purchase dyed fuel for use in on-road vehicles.                         ☐ You blend your own fuel. 
 Check all that ☐ You pick up taxable, on-road fuel from a terminal.                          ☐ You recycle fuel for use on-road. 
  apply. 
                ☐ You make your own fuel.                                                     ☐ You acquire taxable fuel that has not been taxed. 

                                                 Gasoline and/or            Diesel, Biodiesel or              Dyed Diesel, Biodiesel 
 Check each type of fuel you will consume.  ☐    Ethanol              ☐     Kerosene                       ☐  or Kerosene                   ☐       Aviation Fuel 

                                                                            ‐52‐ 
 

 Section 10 – Fuel Customers / Suppliers / Position Holders 
 Supplier of Motor Fuels applicants list customers.  Distributor of Motor Fuels applicants list Suppliers.  Terminal Operator applicants list Position 
 Holders in your terminal(s).  Retailers of Motor Fuels applicants list suppliers.  Transporter applicants skip this section.  Use a rider if necessary. 
 Customer / Supplier / Position Holder                              o    License N  o           Products          Terminal N  o    How product is 
               Name                                   Federal ID N                                                                 received 
                                                           
 Section 11 – Transporters Hired 
 List Common Carriers you will use to transport fuel. 
 Transporter Name       Point of Contact                            Phone Number                Federal ID Number                  Mode 
      
 Section 12 – Terminals 

 Section 12 – Terminals 
 Refer to instructions to determine which Terminals must be listed (attach rider if necessary). 
 Terminal Code                                        Street Address                                              City, State, Zip 
                                                                                                                   
                                                                      ‐53‐ 
 

 Section 13 – New Jersey Storage Tank Information 
 List Storage Tank information by product type.  (Attach rider if necessary). 
  Product Type                                    Address                                           City, State, Zip          Total Tank Capacity 
                                                                                                                 
 Section 12 – Terminals 

 Section 14 – Bond Information 
 Complete the parts applicable to the License you are requesting. 
                                                                  Bond or Security must be 3 times the liability for the estimated gallons handled per 
 Supplier or Permissive Supplier Applicants                       month. (minimum $25,000; maximum $2,000,000) 
                                    List estimated gallons to be handled per month by product types as grouped below 
  Gasoline                          Diesel & Kerosene (dyed & undyed)             Aviation Gasoline                  Jet Fuel 
                                                                                                                      
  Check type of Security to be used 
  ☐ Surety Bond                     ☐ Certificate of Deposit                      ☐ Letter of Credit                 ☐ Cash Deposit 
  Issue of Security Instrument                                    Number                            Issue Date                Amount
   
  Address of Issuer                                                               City, State, Zip 
   
 Terminal Operator Applicants                                     Bond or Security must be 3 times the liability for the estimated gallons handled per month. 
                                    List estimated gallons to be handled per month by product types as grouped below 
  Gasoline                          Diesel & Kerosene (dyed & undyed)             Aviation Gasoline                  Jet Fuel 
                                                                                                                      
  Check type of Security to be used 
  ☐ Surety Bond                     ☐ Certificate of Deposit                      ☐ Letter of Credit                 ☐ Cash Deposit 
  Issue of Security Instrument                                    Number                            Issue Date                Amount
   
  Address of Issuer                                                               City, State, Zip 
   
 Distributor of Motor Fuels Applicants                            Bond or Security must be 3 times the liability for the estimated gallons handled per month. 
                                    List estimated gallons to be handled per month by product types as grouped below 
  Gasoline                          Diesel & Kerosene (dyed & undyed)             Aviation Gasoline                  Jet Fuel 
                                                                                                                      
  Check type of Security to be used 
  ☐ Surety Bond                     ☐ Certificate of Deposit                      ☐ Letter of Credit                 ☐ Cash Deposit 
  Issue of Security Instrument                                    Number                            Issue Date                Amount
   
  Address of Issuer                                                               City, State, Zip 
   
                                                                             ‐54‐ 
 

 Section 15 – Notice of Election for Suppliers and Permissive Suppliers 
    THIS NOTICE OF ELECTION PROVIDES FOR THE PRECOLLECTION OF THE NEW JERSEY MOTOR FUEL TAX ON ALL REMOVALS 
    FROM ALL OUT-OF-STATE TERMINALS LISTED ABOVE WHERE SUPPLIERS OR PERMISSIVE SUPPLIERS ARE POSITION HOLDERS. 
        We elect to treat all removals from all out-of-state terminals with a destination into New Jersey as shown on the terminal-issued shipping 
 papers as if the removals were removed across the rack by the supplier from a terminal in New Jersey as provided in Section 54:39-118. 
        We agree to precollect the New Jersey motor fuel tax in accordance with Chapter P.L 2010. C22 on all removals from a qualified terminal 
 where we are a position holder without regard to the license status of the person acquiring the fuel, the point of terms of the sale or the character 
 of delivery. 
        We further agree to waive any defense that the State of New Jersey lacks jurisdiction to require collection on all out-of-state sales by such 
 person as to which the person had knowledge that the shipments were destined for New Jersey and that New Jersey imposes the requirements 
 under  its general police powers to regulate the movement of motor fuels. 

 NOTICE OF ELECTION must be  signed by  an authorized representative  of the company  as  listed  in Section  5 of 
 this application. 
 Signature                                                                  Title                   Printed Name                           Date Signed 

 Section 16 – Application to be a Qualified Distributor 
 Pursuant to Section 54:39-121, Qualified Distributors may delay remittance of the tax precollected by their Suppliers and Permissive Suppliers until up to 
 the 20 dayth of the month following the removal of taxable products from a terminal by a fuel transportation vehicle.   Payments made to Suppliers and 
 Permissive   Suppliers MUST be made by EFT. 
        We acknowledge our Suppliers’ obligations to precollect tax due on Motor Fuels from us, hold it in trust for New Jersey, and remit the 
 tax precollected no later than the 22ndof the month following the taxable event. 
        We affirm that: 
                     1. Our company was a licensee in good standing with the State of New Jersey under R. S. 54:39-1 et seq.  Our filings and 
                        payments  were made accurately and timely. 
                                                                        — OR — 
                     2. Our company meets the financial responsibility or bonding requirements set forth by the Motor Fuels Tax Act of 2010. 
        We agree that in order to enable our Suppliers to meet their obligations to the State of New Jersey, we MUST remit the amount of tax due 
 to our Suppliers by EFT no later than the 20thday of the month following the taxable event. 

        Based on the above acknowledgment, affirmation, and agreement, we request that the State of New Jersey recognize us as qualified to 
 delay remittance to our Suppliers of tax due until the 20th day of the month following the taxable event.  We recognize that as a Qualified Distributor, 
 recognized pursuant to R. S. 54:39-101 et seq.  We recognize that our company, and not our Suppliers, will be liable for penalties and interest in 
 the  event that we make remittance to our Suppliers late.  We further recognize that a late remittance to our Suppliers will revoke our status as a 
 Qualified Distributor. 
 QUALIFIED DISTRIBUTOR APPLICATION must be signed by an authorized representative of the company as listed in 
 Section 5 of this application. 
 Signature                                                                  Title                   Printed Name                           Date Signed 

 Section 17 – Authorizing Signature 
 Under penalty of perjury, my signature affirms all of the following: 
          The information provided in this application, to include all attachments, is accurate and complete to the best of my knowledge. 
          The applicant agrees to provide accurate and timely reports and to make timely payments. 
 Inaccurate or incomplete information in any section is cause for denial of the requests made in Section 14 or 15, and/or the denial of the entire application. 
 Signature                                                                  Title                   Printed Name                           Date Signed 

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