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- 
 

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 
                                                                             ATLANTIC CITY LUXURY SALES TAX 
submitting the S Corporation election form (CBT-2553). 
                                                                             (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 withNJ-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: www.state.nj.us/treasury/taxation/exemption.htm.                           corporation,  check “YES” and enter the name and FEIN of the parent. 
B. Enter the FEIN assigned to the employer or business by the Internal 
   Revenue Service or if not required, enter the Social Security Number       N.  Enter the four-digit Standard Industrial Code (SIC) if known. 
   assigned to the sole proprietor.  Check the box if you have applied for    O.  Enter the six-digit North American Industrial Classification System 
   your FEIN.                                                                     Code  (NAICS) if known from Table C, page 14-15. 
C. Enter the corporate name of the business being registered or the name(s)   P.  Enter the names of the owner, partners or responsible corporate 
   of the owner(s) if a sole proprietor or partnership.                           officer(s).  Enter the social security number, title, and home address for 
                                                                                  each person listed. 
D. Enter  the Trade Name, if different from Item C.                               
E. Enter the address of the physical location of the business, do not use a   PAGE 18 INSTRUCTIONS 
   PO Box   address.  Be sure to include the nine-digit zip code.             Question 1: 
F. Enter the name and address to which all New Jersey tax returns will be     a.  Have you or will you be paying wages, salaries or commissions to 
   mailed.  Be sure to include the nine-digit zip code.  If you wish to have      employees working in New Jersey within the next 6 months.  If yes check 
   different type tax returns go to different addresses, please attach a          “YES” and enter the date of the first payment.  This date must be 
                                                                                  provided for Unemployment and Disability registration purposes.  If no 
   separate sheet and indicate the address to which each tax return is to go.     check “NO” please be aware that if you begin paying wages you are 
G. Enter the date which you started or assumed ownership of this business         required to notify the DORES’ Customer Service Center at 609-292-
   in New Jersey.  If your business has not yet started, enter the date that       9292. 
   you will commence doing business.  If you are renting out transient 
   accommodations, the earliest date you may use is October 1, 2018.  If no   b.  If 1(a) is “YES” enter the date you hired your 1st New Jersey employee. 
   business is conducted in NJ, but, you are going to withhold NJ Gross       c.  This date must be provided for Unemployment and Disability 
   Income Tax for employees, enter the date withholding will begin.  Use          registration purposes.  Accumulate the gross periodic payrolls until they 
   today’s date if you only need a Business Registration Certificate.             add up to a total of $1,000.  Enter that date on line 1c. 
H. Check the appropriate box for your Type of Ownership. If you check “S      d.  If you will be paying wages, salaries or commissions to New Jersey 
   Corporation” complete the New Jersey S Corporation Election form               residents  working outside New Jersey, check “YES”. 
   (CBT-2553)   found in this booklet on pages 40-41.                         e.  If you will be the payer of pensions and/or annuities to New Jersey 
I. Enter your New Jersey Business Code from Table A, pages 9-11.  If you          residents, check “YES” and enter the date of the first payment. 
   are engaged in more than one type of business, enter the code for the      f.  If you will be holding legalized games of chance in New Jersey (as 
   predominant one.  This section must be completed to avoid delays in            defined in Chapter 47 “Rules of Legalized Games of Chance”) where 
   issuance of the Certificate of Authority or License.                           proceeds from any one prize exceed $1,000, check “YES” and enter the 
J. Enter your New Jersey County/Municipality Code from Table B, pages             date of the first prize awarded (NJ Lottery proceeds are not included). 
   12-13.  This code reflects the County/Municipality in which your           g.  A PEO (Employee Leasing Company) that registers with DORES is 
   business is located.                                                           subject to an additional and separate registration process with the NJ 
K.  Enter the county where your business is located.                              Department of Labor and Workforce Development.  To obtain the 

                                                                          -6- 
 

     special PEO registration forms and information, please visit the              employs agricultural workers) is generally subject to FUTA if it had covered 
     Department of Labor and Workforce Development’s website at                    employment during some portion of a day in 20 different calendar weeks 
     www.state.nj.us/labor/ea/eaindex.html 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                  www.state.nj/treasury/taxation/pmtmf.shtml. 
                                                                                       b.  If your company is engaged in refining and/or distributing petroleum 
     Wildwood, Wildwood Crest or Wildwood, check the applicable box.                       products for distribution in this State, or importing petroleum products 
 d. All NJ locations collecting NJ sales tax must be registered.  If “YES”                 into New Jersey for consumption in New Jersey, check “YES.”  If you 
    attach a rider requesting consolidated reporting.                                      have checked “YES” complete Form REG-L and return it with your 
 e. If you sell, store, deliver or transport natural gas or electricity to users           competed NJ-REG 
    or customers whether by mains, lines, or pipes located within this                 c.  If you checked “YES” you will be sent a Direct Payment Permit 
    State or by any other means of delivery, check “YES”.                                  application. 
                                                                                     
Question 12:                                                                        Question 18: 
If you intend to sell cigarettes in New Jersey, check “YES”.  If “YES”              If you will be providing merchandise or services to casino licensees or acting 
complete Form CM-100 if you are applying for a retailer or vending machine          as a contractor or subcontractor to the State or its agencies, check the “YES” 
license.  You will be sent the appropriate license/license application after these  box. 
forms are processed.                                                                 
                                                                                    Question 19: 
Question 13:                                                                        Businesses involved in the rental of motor vehicles (less than 28 day 
 a. If you are engaged in the business of selling tobacco products in this          agreements), including passenger autos, trucks and trailers designed for use 
    State, if you import tobacco products into this State for sale within this      on the highways, other than those used for the transportation of commercial 
    State, if you make or manufacture tobacco products within this State            freight, are subject to the payment of a $5 per day Domestic Security Fee.  If 
    for sale in the State, if you sell tobacco products outside this State and       eligible, a business must check YES. 
    ship or transport those products to a person in this State to be sold to 
    a retail dealer, or you are a person that receives tobacco products             For additional information on the Domestic Security Fee, please visit the 
    without receiving proof that the tax has been or will  be paid by               Division of Taxation’s at https://www.state.nj.us/treasury/taxation/dsf.shtml. 
    another distributor, then you are a distributor of tobacco products.             
                                                                                    Question 20: 
    Please   check “YES.”                                                           If you are engaged in the rental of rooms in a hotel, motel, bed & breakfast or 
 b. If you purchase tobacco products from any other person  who                     similar facility or you provide other transient accommodation rentals (e.g., 
    purchases from the manufacturer and acquires the tobacco products               vacation rental, house, room, or similar lodging used on a transient basis), you 
    solely for resale to retail dealers or to other persons for the purposes        are required to collect a State Occupancy Fee.  In addition, a Municipal 
    of resale only, or you service retail outlets by the maintenance of an          Occupancy Tax of up to 3% must also be collected, if enacted by the 
    established place of business for the purchase of tobacco products, you         municipality where the facility is located.  If such a facility, check YES.  You 
    are a wholesaler of tobacco products.  Please check “YES.”                      will receive the HM-100 return, which must be filed with payment by the 20th 
    Tobacco products include, but are not limited to cigars, little cigars,         of each month.  Additional information on the Fee and a list of municipalities 
    cigarillos, chewing tobacco, pipe tobacco, smoking tobacco and their            that have enacted the Tax is available on the Division of Taxation’s website: 
    substitutes, dry and moist snuff, and liquid nicotine, but does not             https://www.state.nj.us/treasury/taxation/transientbuffer.shtml. 
    include cigarette as defined in section 10 of the "Cigarette Tax Act"            
                                                                                    Question 21: 
    P.L.1948,c.65(C.54:40A-1et    seq.).                                            For businesses that operate in the Sports and Entertainment District in 
    If the distributor or wholesaler has not collected the Tobacco and              Millville, NJ a 2% local tax is imposed on receipts from sales (including 
    Nicotine Products Wholesale Sales and Use Tax from the retailer or              rentals) of tangible personal property, prepared food and beverages, rents for 
    consumer, then the retailer or consumer is responsible for remitting            hotel or motel room occupancies or other transient accommodation rentals 
    the compensating use tax on the price paid or charged directly to the           (e.g., vacation rentals, houses, rooms, or similar lodging used on a transient 
    Division of Taxation within 20 days of the date the tax was required            basis), and certain admission charges. 
    to be paid.                                                                     Taxpayers subject to the tax must file a quarterly SETMI Return, (Form SM- 
                                                                                    100) and remit any tax due on or before the 20th day of the month following 
Question 14:                                                                        the end of the calendar quarter.  Additional information on the tax, including 
If you are a manufacturer, wholesaler, distributor or retailer of litter generating filing instructions, is available on the Division of Taxation’s website at: 
products, check “YES.” Litter-generating products are:  food, soft drinks and       https://www.state.nj.us/treasury/taxation/sports.shtml. 
carbonated water, beer, wine, distilled spirits, glass containers, metal             
containers, plastic or fiber containers, groceries, drugstore sundries, cigarettes  Question 22: 
and tobacco products, motor vehicle tires, newsprint and magazine paper             If you sell new tires, or sell or lease motor vehicles, you must check “YES”.  
stock, paper products and household paper, and cleaning agents and toiletries       You will receive information regarding the collection of the Motor Vehicle 
                                                                                    Tire Fee. 
Question 15:                                                                         
If you are an owner or operator of a sanitary landfill facility in New Jersey,      Question 23: 
check “YES” and indicate the facility number and type as classified by the          If you are a telephone exchange company or a mobile telecommunications 
New Jersey Department of Environmental Protection.    Registration                  carrier which provides voice grade access telephone numbers or service lines 
instructions for the Solid Waste Services and Landfill Closure and  as part of that telephone exchange service, thereby providing access to 9-1-1 
Contingency taxes will be forwarded.                                                service through the public switched network, you must check “YES”.  You 
                                                                                    will receive the ERF-100 return which is due on a quarterly basis. 
Question 16:                                                                         
 a. If you operate a facility that has the total combined capacity to store         Question 24: 
     200,000 gallons or more of petroleum products, check “YES.”                    Contact Person: Enter the name, title, telephone number and e-mail address 
 b. If you operate a facility that has the total combined capacity to store         of the contact person who will answer questions regarding the registration 
                                                                                    application. 
    20,000   gallons of hazardous chemicals, check “YES.”                            
 c. If you store petroleum products or hazardous chemicals at a public              Signature: The application must be signed and dated by the owner if a sole 
    storage terminal, check “YES” and enter the name of the terminal.  A            proprietorship, or in the case of a corporation, by the president, vice-president, 
    Spill Compensation and Control Tax registration application will be             secretary, treasurer, comptroller, or other duly authorized officer.  Unsigned 
    forwarded.                                                                      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             07090708 GlenIrvingtonRidgeTownshipBorough             MERCER COUNTY 
  0230   Little Ferry Borough       
  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 
                                       1428    Netcong Borough                 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 
                                       1608    Paterson City                   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, HistoricalSites,   &   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 & videoIndustries      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 Activitiesfor   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.state.nj.us/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.state.nj.us/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    
 (7-2018)  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)  F. Mailing Name and Address: (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 
 
          -       -                
 
          -       -                
 
          -       -                
 
OWNERSHIP DETAIL                                                
 
          -       -                
              
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        Date DayAcquired    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 adistributor orwholesaler 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 athttps://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 you can download this application atwww.statenj.us/treasury/taxation/prntmf.shtml.        . ☐ 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 http://www.state.nj.us/njbgs 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 eventthat                             
           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) 
 
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 14A:2-2.1 (2) New Jersey Business Corporation Act                    Title 42:2B-4 Limited Liability Company 
           ☐                                                                      ☐   
                   Title 15A:2-2-3 (b) New Jersey Nonprofit Corporation Act                   Title 42:2A-6 Limited Partnership 
          ☐                                                                       ☐ 
 
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                              http://www.nj-newhire.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 http://www.nj-newhire.com. 
       
   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, or visit the IRS’s World Wide Web site at http://www.irs.ustreas.gov. 
       
   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 www.nj-newhire.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 
 
Download (or complete on line) the Multistate Employer Notification Form from the following, OCSE employer web site address: 
http://www.acf.hhs.gov/programs/cse/newhire/employer/private/nh/newhire.htm. 
 
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:www.acf.dhhs.gov/programs/cse/ (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.state.nj.us/njbgs/. 
         
        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.state.nj.us/njbgs/ 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, 
      ☐ Business Incorporated                                                                             cancel, withdraw, merge, or consolidate.  Forms and Instructions for 
                                                                                                          these changes may be obtained online at www.state.nj.us/njbgs/ or by 
      ☐ Owner Deceased                                                                                    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 QSSS Election 
Check the appropriate box:   ☐ Initial S Corporation Election       New☐ Jersey QSSS Election (See Part V)     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 
                                                                                                                                                                                                           (           )               - 
Check here  ☐ if the corporation has changed its name or address in the past 12 months                                              Date of Incorporation                         State of Incorporation 
                                                                                                                                                     /            /                
          Election Information 
Enter theeffective date of the Federal S corporation 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 
  
  1.    Purpose - A corporation must file form CBT-2553 to elect to be                       outstanding shares of stock on the day of revocation should be 
        treated as a New Jersey S corporation or a New Jersey QSSS or                        mailed to the address in instruction 3 on or before the last day of 
        to report a change in shareholders.  Check the appropriate box to                    the first tax year to which the election would otherwise apply.  A 
        indicate if this is an initial S corporation election or a change in                 copy of the original election should accompany the letter of 
        S or QSSS corporation shareholders or a New Jersey QSSS                              revocation.  Such a revocation will render the original election 
        election.                                                                            null and void from inception. 
  2.    Who may elect - A corporation may make the election to be                     7.     Initial election - Complete Parts I, II and III in their entirety for 
        treated as a New Jersey S corporation only if it meets all of the                    an initial New Jersey S Corporation election.  Each shareholder 
        following criteria:                                                                  who owns (or is deemed to own) stock at the time the election is 
        a)        The corporation is or will be an S corporation pursuant                    made, must consent to the election.  A list providing the social 
                  to section 1361 of the Federal Internal Revenue Code;                      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            8.     Reporting shareholders who were not initial shareholders - 
                  in Part II of this form;                                                   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, PO Box 252, Trenton, NJ 08646-0252 (Registered                              consent statement, the corporation is obligated to fulfill the tax 
        Mail Receipt is suggested).                                                          requirements as stated in Part III on behalf of the nonconsenting 
  4.    When to make the election - The completed form CBT-2553                              shareholder.  An existing shareholder whose percentage of stock 
        shall be filed within one calendar month of the time at which a                      ownership changes is not considered a new shareholder.  If the 
        Federal S corporation election would be required.  Specifically,                     taxpayer previously had elected to be treated as a New Jersey 
        it must be filed at any time before the 16th day of the fourth                       QSSS, the new shareholder must also complete Part V. 
        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 - The Division of                           S Subsidiary and remit only a minimum tax.  In addition, the 
        Revenue will notify you if your election is accepted or not                          parent company also must consent to filing and remitting New 
        accepted within 30 days after the filing of the CBT-2553 form.                       Jersey Corporation Business Tax which would include the 
        If you are not notified within 30 days, call 609-292-9292.                           assets, liabilities, income and expenses of its QSSS along with 
  6.    End of election -   Generally, once an election is made, a                           its own.  Failure of the parent either to consent or file a CBT-100 
        corporation remains a New Jersey S corporation as long as it is                      or CBT-100S for a period will result in the disallowance of the 
        a Federal S corporation.  There is a limited opportunity to revoke                   New Jersey QSSS election and require the subsidiary to file and 
        an election only during the first tax year to which an election                      remit a CBT-100S determining its own liability. 
        would otherwise apply.  To revoke an election, a letter of 
        revocation signed by shareholders holding more than 50% of the 
  
                                                                   -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 ofclaims 
        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 
 check or money order payable to “Treasurer, State of NJ.” 
 together with a payment for the total fee amount below. Please make your         Authorized Signature                                                             Date        
                                                                                   
   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 stateList(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 

                                                                            -55-