The Pennsylvania PA-100 form is an essential document used for registering a business entity in the state of Pennsylvania. This form collects vital information about the enterprise, including its structure, ownership, and tax obligations. Completing the PA-100 accurately is crucial for compliance with state regulations and ensuring a smooth business operation.
The Pennsylvania PA-100 form is a crucial document for businesses operating within the state, serving as the Enterprise Registration Form. This form must be completed and submitted to the Pennsylvania Department of Revenue, specifically the Bureau of Business Trust Fund Taxes. It captures essential information about the enterprise, including its legal structure, business activities, and tax obligations. Businesses are required to indicate the reason for registration, whether it’s a new registration, a change in business structure, or an update of existing information. The form also collects details such as the enterprise's name, address, federal employer identification number, and the types of taxes and services requested. Additionally, it includes sections for listing owners, partners, and responsible parties, ensuring that all key individuals are documented. For enterprises with multiple establishments, there are specific instructions to follow, ensuring compliance with state regulations. Completing the PA-100 accurately is vital for maintaining good standing with state authorities and fulfilling tax obligations.
PA-100 (03-09)
MAIL COMPLETED APPLICATION TO:
DEPARTMENT OF REVENUE
BUREAU OF BUSINESS TRUST FUND TAXES
PO BOX 280901
HARRISBURG, PA 17128-0901
TYPE OR PRINT LEGIBLY, USE BLACK INK
COMMONWEALTH OF PENNSYLVANIA
PA ENTERPRISE
REGISTRATION FORM
DEPARTMENT USE ONLY
RECEIVED DATE
DEPRTMENT OF REVENUE & DEPRTMENT OF LR D INDUSTRY
SECTION 1 – REASON FOR THIS REGISTRATION
REFER TO THE INSTRUCTIONS E D CHECK THE ICE BOXTO INDI
CTE THE RENFOR THIS REGISTRTION.
.
NEW REGISTRTION
DING T& SERVICE
RETIVTING T& SERVICE
4. DING ESTISHMENT
5. INFORMTION UPDTE
6. DID THIS ENTERPRISE:
YES
NO
QUIRE L OR PRT OF OTHER BUSINESS?
RESULT FROM CHGE IN LEG STRUCTURE OR EXE FROM INDIVIDU
PROPRIETOR TO CORPORTION PRTNERSHIP TO CORPORTION COR
PORTION
TO LIMITED LILITY COMPYETC
UNDERGO MERGER CONSOLIDTION DISSOLUTION OR OTHER REST
RUCTURING?
SECTION 2 – ENTERPRISE INFORMATION
DTE OF FIRST OPERTIONS
. DTE OF FIRST OPERTIONS IN P
ENTERPRISE FISC YE END
4.
ENTERPRISE LEG N
5. FEDER EMPLOYER IDENTIFICTION NUMBER N
6. ENTERPRISE TRE Nf different than legal name
. ENTERPRISE TELEPHONE NUMBER
ENTERPRISE STREETDRESS
do ot use PO Box
CITY/TOWN
COUNTY
STTE
ZIP CODE + 4
. ENTERPRISE MLING DRESS f different than street address
CITY/TO
WN
. LOCTION OF ENTERPRISE RECORDS reet address
. ESTISHMENT Noing business as
. NUMBER OF
PSCHOOL DISTRICT
4. P
MUNICIPLITY
ESTISHMENTS *
*ENTERPRISES WITH ONE OR MORE ESTABLISHMENTS WITHIN PA, WHOSE PA ADDRESS WAS NOT ENTERED ABOVE, MUST COMPLETE SECTION 17 (SEE GENERAL INSTRUCTIONS AND SECTION 17 FOR MORE INFORMATION)
SECTION 3 – TAXES AND SERVICES
LL REGISTRTS MUST CHECK THE ICE BOXTO INDICTE THE TD SERVIC
EREQUESTED FOR THIS REGISTRTION D CO
MPLETE THE
CORRESPONDING SECTIONS INDICTED ON PES D . IF RETIVT
ING Y PREVIOUS COUNT LIST THE COUNT NUMBERIN THE SPE PROVID
ED.
PREVIOUS
ACCOUNT NUMBER
CIGETTE DEERʼS LICENSE
CORPORTION T
EMPLOYER WITHHOLDING TX
FUELS TPERMIT
LIQUID FUELS TPERMIT
MOTOR CRIERS RO TIFT
PROMOTER LICENSE
PUBLIC TRSPORTTION
STCE TLICENSE
SES TEXEMPT STTUS
SECTION 4 – AUTHORIZED SIGNATURE
SES USE HOTEL OCCUPCY
TLICENSE
SML GOF CHCE LIC./CERT.
TRSIENT VENDOR CERTIFICTE
UNEMPLOYMENT COMPENSTION
USE TX
VEHICLE RENTTX
WHOLESER CERTIFICTE
WORKERSʼ COMPENSTION COVERE
I ETHE UNDERSIGNED DECLE UNDER THE PENTIES OF PERJURY THT TH
E STTEMENTS CONTNED HEREIN E TRUE CORRECTD COM
PLETE.
THORIZED SIGNTURETTH POWER OFTTORNEY IF ICE
DYTIME
TELEPHONE NUMBER
TITLE
TYPE OR PRINT N
ELDRESS
DTE
TYPE OR PRINT PREPERʼS N
DYTIME TELEPHONE NUMBER
4
DEPRTMENT USE ONLY
ENTERPRISE N
SECTION 5 – BUSINESS STRUCTURE
CHECK THE OPRITE BOX FOR QUESTIONS & . IN DITION TO SEC
TIONS THROUGH COMPLETE THE SECTIONINDICTED.
. SOLE PROPRIETORSHIP NDIVIDU
GENER PRTNERSHIP
CITION
CORPORTION c.
LIMITED PRTNERSHIP
BUSINESS TRUST
GOVERNMENT c.
LIMITED LILITY PRTNERSHIP
ESTTE
JOINT VENTURE PRTNERSHIP
LIMITED LILITY COMPY
STTE WHERE CHTERED
RESTRICTED PROFESSION COMPY
PROFIT
NONOFIT
IS THE ENTERPRISE ORGIZED FOR PROFIT OR NONOFIT?
IS THE ENTERPRISE EXEMPT FROM TTION UNDER INTERN REVENUE CODE RCSEC
TION 5 IF YES
PROVIDE COPY OF THE ENTERPRISE'S EXEMPTION THORIZTION LETTER FROM T
HE INTERN REVENUE SERVICE.
SECTION 6 – OWNERS, PARTNERS, SHAREHOLDERS, OFFICERS, AND RESPONSIBLE PARTY INFORMATION
PROVIDE THE FOLLOWING FOR ALL INDIVIDUD/OR ENTERPRISE OWNERS PRTNERS SHEHOLDERS OFFICERS
D RESPONSIBLE PRTIES. IF STOCK IS PUBLICLY
TRED PROVIDE THE FOLLOWING FOR ANY SHAREHOLDER WITH AN EQUITY POSITION OF 5% OR MORE ADDITIONAL SPACE IS AVAILABLE IN SECTION 6A, PAGE 11
N
. SOCI SECURITY NUMBER
DTE OF BIRTH *
4. FEDER EIN
5.
OWNER
OFFICER
6. TITLE
. EFFECTIVE DTE
PERCENTE OF
. EFFECTI
VE DTE OF
PRTNER
SHEHOLDER
OF TITLE
OWNERSHIP
RESPONSIBLE PRTY
%
. HOME DRESS reet
. THIS PERSON IS RESPONSIBLE TO REMIT/MNTN:
SES T
MOTOR FUEL T
* DTE OF BIRTH REQUIRED ONLY IFYING FOR CIGETTE WHOL
ESE DEERʼS LICENSE SML GOF CHCE DISTRIBUTOR LICENSE OR SML
G
OF CHCE MUFTURER CERTIFICTE.
SECTION 7 – ESTABLISHMENT BUSINESS ACTIVITY INFORMATION
REFER TO THE INSTRUCTIONS ON PAGES 20 & 21 TO COMPLETE THIS SECTION COMPLETE SECTION 17 FOR MULTIPLE ESTABLISHMENTS
. ENTER THE PERCENTE THT EH
PABUSINESS ACTIVITY REPRESENTS OF THE TOTL RECEIPTS OR REVENUEST
THIS ESTISHMENT. LIST
PRODUCTS OR
SERVICES CITED WITH EH BUSINESS TIVITY D THE PERCENTE REPRESENTING THE TO
TL RECEIPTS OR REVENUES.
PA BUSINESS ACTIVITY
PRODUCTS OR SERVICES
ADDITIONAL
mmodation & Food Services
riculture Forestry Fishing & Hunting
Entertainment & Recreation Services
Communications/Information
Construction st complete question
Domestics vate Households
Educational Services
Finance
Health Care Services
Insurance
Management Support & Remediation Services
Manufacturing
Mining Quarrying & Oil/Gas Extraction
Other Services
Professional Scientific & Technical Services
Public ministration
Real Estate
Retail Trade
Sanitary Service
Social stance Services
Transportation
Utilities
Warehousing
Wholesale Trade
TOTL
. ENTER THE PERCENTE THT
THIS ESTABLISHMENTS RECEIPTS OR REVENUES REPRESENT OF THE TOTAL PARECEIPTS OR REVENUES OF THE ENTERPRISE.
______________%. SINGLE ESTBLISHMENT ENTERPRI SES ENTER %. MULTIPLE ESTISHMENT ENTERPRISES ENTER PERCENTE OF ENTERPRISE SEC
TION
. ESTISHMENTS ENGED IN CONSTRUCTION
MUST ENTER THE PERCENTE OF CONSTRUCTION TIVITY THT IS NEW D/OR
RENOVTIVE D THE PERCENT
E OF CONSTRUCTION TIVITY THT IS RESIDENTID/OR COMMERCI
___________________% NEW
+
__________________% RENOVTIVE
=
___________________% RESIDENTIL
__________________% COMMERCIL
4. YES NO
DOES THIS ENTERPRISE WNT TO BECOME PENNSYLVNILOTTERY
RETLER?
5
SECTION 8 – ESTABLISHMENT SALES INFORMATION
IS THIS ESTISHMENT SELLING TE PRODUCTS OR OFFERING TE SERVICES TO
CONSUMERS FROM LOCTION
IN PENNSYLVANIA? IF YES COMPLETE SECTION .
IS THIS ESTISHMENT SELLING CIGETTES
IN PENNSYLVANIA? IF YES COMPLETE SECTIONS D .
. LIST EH COUNTY
IN PENNSYLVANIA WHERE THIS ESTISHMENT IS CONDUCTING TE SES TIVITYES
ATTACH ADDITIONAL 8 1/2 X 11 SHEETS IF NECESSARY.
SECTION 9 – ESTABLISHMENT EMPLOYMENT INFORMATION
PART 1
. YES
DOES THIS ESTISHMENT EMPLOY INDIVIDUS WHO
WORK IN PENNSYLVANIA? IF YES INDICTE:
a.
DTE WES FIRST
PAID DD/YYYY
. . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b.
DTE WGES RESUMED FOLLOWING BREIN EMPLOYMENT
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c.
TOTL NUMBER OF EMPLOYEES
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .
d.
NUMBER OF EMPLOYEES PRIMILY WORKING IN NEW BUILDING OR INFRRUC
TURE
e.NUMBER OF EMPLOYEES PRIMILY WORKING IN REMODELING CONSTRUCTION . . . . . . . . . . . . . . . . . . . . . .
f. ESTIMTED GROSS WGES PER QUTER
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .$
g.NOF WORKERSʼ COMPENSTION INSURCE COMPY
POLICY NUMBER _________________________________E FFECTIVE STRT DTE __________________END DTE __
_________________
GENCY NME _____________________________________ _________________DYTIME TELEPHONE NU MBER ______________________
MLING DRESS
_____________________________________CITY/TOWN ______________________STTE _____ZIP CODE + 4_ _______
IF THIS ENTERPRISE DOES NOT HVE WORKERSʼ COMPENSTIONINSURCE CHECK
ONE:
THIS ESTISHMENT EMPLOYSONLY EXCLUDED WORKERS . . . .
. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .THIS ESTISHMENT HZERO EMPLOYEES
. . . . . . . . . . . . . . . . . . . . . . . . . .
c.THIS ESTISHMENT RECEIVED OVTO SELFNSURE BY THE PBURE OF
WORKERSʼ COMPENSTION
. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
IF ITEM c. IS CHECKED PROVIDE PWORKERSʼ COMPENSTION BURE CODE
DOES THIS ESTISHMENT EMPLOY PRESIDENTS WHO
WORK OUTSIDE OF PENNSYLVANIA?
IF YES INDICTE:
PAID DD/YYYY . . .
. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . .DTE WGES RESUMED FOLLOWING BREIN EMPLOYMENT
. . . . . . . . . . . . . . . . .
ESTIMTED GROSS WGES PER QUTER.
. . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .$
DOES THIS ESTISHMENT PY REMUNERTION FOR SERVICES TO PERSONS YOU DO
NOT CONSIDER EMPLOYEES?
IF YES EXPLN THE SERVICES PERFORMED
PART 2
IS THIS REGISTRTION
RESULT OF TE DISTRIBUTION FROM
BENEFIT TRUST DEFERRED PYMENT OR RETIREMENT PL
FOR PRESIDENTS?
DTE BENEFITS FIRST PAID DD/YYYY
. . . . . . . . . . .
b. ESTIMTED BENEFITS PID PER QUTER
. . . . . . . . . . . . . . . . . . . . . .$
SECTION 10 – BULK SALE/TRANSFER INFORMATION
IF S WERE QUIRED IN BULK FROM MORE TH ONE ENTERPRISE PHOTOCOPY T
HIS SECTION D PROVIDE THE FOLLOWING INFORMTION
UT EH
SELLER/TRSFEROR.
DID THE ENTERPRISE QUIRE 5% OR MORE OF
ANY CLASS OF THE PA ASSETS OF OTHER ENTERPRISE? SEE THE CLOF S
LISTED BELOW.
DID THE ENTERPRISE QUIRE 5% OR MORE OF THE
TOTALASSETS OF OTHER ENTERPRISE?
IF THE SWER TO EITHER QUESTION IS YES PROVIDE THE FOLLOWING INFO RMTION UT THE
SELLER/TRANSFEROR
. SELLER/TRSFEROR N
5. SELLER/TRSFEROR STREETDRESS
6. DTE S QUIRED
. S QUIRED:
COUNTS RECEIVE
EQUIPMENT
INVENTORY
ND/OR GOODWILL
CONTRTS
FIXTURES
LE
RE ESTTE
CUSTOMERS/CLIENTS
FURNITURE
MHINERY
OTHER
IMPORTANT: IF, IN ADDITION TO ACQUIRING ASSETS IN BULK, THE ENTERPRISE ALSO ACQUIRED ALL OR PART OF A PREDECESSOR'S BUSINESS, SECTION 14 MUST BE COMPLETED.
IF THE ENTERPRISE IS ACQUIRING 51% OR MORE OF ANY CLASS OF PA ASSETS AND/OR 51% OF THE TOTAL ASSETS OF ANOTHER ENTERPRISE THE SELLER MUST OBTAIN A BULK SALE CLEARANCE CERTIFICATE. REFER TO INSTRUCTIONS ON PAGE 22.
6
SECTION 11 – CORPORATION INFORMATION
. DTE OF INCORPORTION
STTE OF INCORPORTION
. CERTIFIC
TE OF THORITY DTE
ONCORP.
4. COUNTRY OF INCORPORTION
IS THIS CORPORTION'S STOCK PUBLICLY TRED?
6.
CHECK THE OPRITE BOX TO DESCRIBE THIS CORPORTION:
CORPORTION:
STOCK
PROFESSION
BK:
MUTU
THRIFT: STTE
INSURCE
P
NONOCK
COOPERTIVE
FEDER
COMPNY:
NON
MEMENT
STTUTORY CLOSE
. S CORPORTION:
INCORDCE WITHT NO.6 OF 6 CORPORTION WITH
FEDER SUBHER S STTUS IS CONSIDERED PS COR
PORTION. IN ORDER
NOT TO BE T P S CORPORTION REV6
MUST BE FILED. THE FORM C BE CESSED T
WWWREVENUESTATEPAUS FORMS D PUBLICTIONS CORPORTION T
COMPLETING THIS FORM WILL NOT FULFILL THE REQUIREMENT TO REGISTER FOR CORPORATE TAXES REGISTERING CORPORATIONS MUST CONTACT THE PA DEPART- MENT OF STATE TO SECURE CORPORATE NAME CLEARANCE AND REGISTER FOR CORPORATION TAX PURPOSES CONTACT THE PA DEPARTMENT OF STATE AT (717) 787- 1057, OR VISIT wwwaoeforbusiessstateaus
SECTION 12 – REPORTING & PAYMENT METHODS
. THE DEPRTMENT OF REVENUE REQUIRES THTY ENTERPRISEMNG PYMENTS EQ
U TO OR GRETER TH $ REMIT PYMENTS VI ONE
OF THE FOL
LOWING ELECTRONIC METHODS: ELECTRONIC FUNDS TRSFER T ELECTRO
NIC TINFORMTION D DTEXCHGE SYSTEM IDES TELEFILE SYSTEM OR
CREDIT CD. ENTERPRISE REGDLESS OF UNTIS ENCOURED TO REMIT
TPYMENTS ELECTRONICLY.
a. YES
b. YES
DOES THIS ENTERPRISE MEET THE DEPRTMENT OF REVENUEʼS REQUIREMENTS FOR ELECT RONIC PYMENTS?
DOES THIS ENTERPRISE WNT TO PRTICIPTE IN THE DEPRTMENT OF
REVENUEʼS ELECTRONIC PROGR
IF THIS ENTERPRISE IS NONOFIT ORGIZTION THT IS EXEMPT UN
DER IRC 5 OR POLITIC SUBIVISIONS IS IT
INTERESTED IN RECEIVING INFORMTION UT THE DEPRTMENT OF LR &
INDUSTRYʼS OPTION OF FINCING UC COSTS
UNDER THE REIMBURSEMENT METHOD IN LIEU OF THE CONTRIBUTORY METHOD? FOR MORE DETILS REFER TO SECTION
INSTRUCTIONS.
THE DEPRTMENT OF LR & INDUSTRY REQUIRES THTY ENTERPRISE WITH
5 OR MORE WGE ENTRIES PER QUTERLY REPORTFILE THE W
GE INFORMTION VI
MNETIC MEDIY MNETIC REPORTING FILE MUST BE SUBMITTED FOR COMPTI
BILITY WITH THE DEPRTMENT OF LR & INDUSTRYʼS FORMT. CONTT
THE M
NETIC MEDI REPORTING UNITT FOR MORE INFORMT
ION.
THE COMMONWETH STRONGLY RECOMMENDS THT ENTERPRISES USE ELECTRONIC FIL
ING D PYMENT OPTIONS FOR CERTN PENNSYLVNI TD SERVICES.
INFORMTION UT INTERNET FILING OPTIONS C BE FOUND ON THE
eIDES WEB SITET
wwwetidesstateaus
SECTION 13 – GOVERNMENT STRUCTURE
. IS THE ENTERPRISE
GOVERNMENT BODY
GOVERNMENT OWNED ENTERPRISE
GOVERNMENT & PRIVTE SECTOR
OWNED ENTERPRISE
. IS THE GOVERNMENT:
DOMESTIC/US
FOREIGN/NONS
MULTITION
. IF DOMESTIC IS THE GOVERNMENT:
LOC:
BOROUGH
STTE GOVERNOR'S JURISDICTION
CITY
SCHOOL DISTRICT
STTE NONOVERNOR'S JURISDICTION
TOWN
TOWNSHIP
7
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