Form ss-4 Application for Employer ldentification Number OMB No.

1545-0003
(Rev January 2010) I (ro1.1t1e-
by employers, goporgtions, partnerships, trusts, estates,
churches.
sovernment aienbies' tnoibn ridai i,iuiiii,'JJil"-ih'iiaiviouars, and others.) lE-
Departmenr o,the rreasury | |

1 Legal name of entity lor individu"

K""O u
"oOV
ror rour r."ord
I
I PattvsPacks
2 Trade name of business (if different t n"rr," * i* f rf 3 Executor, administrator, trustee, ..care of,, nurne
G "rn
-g Patty Jones
o
sa streetaddresstir@
'i 123 Main Street, Unit 12
ct 4b City,state,"nOZta@ 5b City state, and ZIP code (if foreign, see instructions)
o Chicago, tL 60600
o uounry and state where principal business is located
o.
Cook Countv. lL
7a Name of responsible party
7b SSN, lTlN. or EIN
Patty Jones
12345-678S
rs rnrs applcauon ror a ttmited tiability company (LLC)
{or 8b lf 8a is "Yes," enter the number of
a foreign equivalent)?
I yes V] No LLC members
Bc 9a was the LLC in the United States?
Type of l"tt
"ntity
Z Sot" proprietor {SSN) 123i4si 6789
I Estat* (SSN of decedent)
I Partnership
I Ptan administrator fftN)
I Corporation {enter form number to be filed) } fl Trust filN of grantor)
I Personal service corporation
fl
I Churcn or church-controlled organization
Nationat cuard I Statellocal government
n Furmeru,cooperative I Federal government/military
! 9t|rer
nonprofit organization {specify) >_ [f REMIC f]lndiun tribal governmentslenterprises
E Number {GEN) if anv }
9b lf a corporation, name the state or toreigncountry
(if applicable) where incorporated Foreign country

10 Reason for apptying (check only one box)

T Banking purpose (specify purpose) )
n StarteO new business (specify type) > n Changed type of organization {specify new type) }
n Purchased going business
a Hired employees (Check the box and see line .13.)
n Created a trust ispecify type) >
D Compliance with IRS withholding regulations I Created a pension plan (specify type) >
'11 Date business started or acquired {month, day,
Vurrt. S"" i*tr*tioo,, month of year December
01,2005
t3 lf you expect your employment tax liability to be $1,000
Highest number of employees expected in the next 12 months
Gnt* {.if n""e), or less in a full calendar year and want to file Form g44
lf no employees expected, skip line 14. annually instead of Forms 941 quarterlv, check here.
(Your employment tax liability generally will be $1
,000
Agricultural Household Other
J
FirstdatewageSorannuitieswerepaid(month,day,yea't.r,r"t..
nonresident alien (month, day, year) .

I construction n Rental &leasing I Transportation&warehousinn - A""or*odation&foodservice I

finance & jnsurance
wholesale-other Z Retait
n Otner (spec,fy)
,.0*t" pro,
Backpacks
18 Has the anOfican
lf "Yes," write previous EIN here ) ;

Complete this section only ii you want t0 auth0rize th, nu*

Third Designee's telephone number {include area code)
Party
)
Designee
Designee's tax number (include area code)

Ulderpenaltiesolperjury,|declarethatlhaVeeXaminedthi.app|lca|0n.andtotnenesi
Applicant's telephone numbel {include area code}
Name and titie (typ€ or print ctetrty) > pattv JOneS
{)
Applicant's iax number $nclude area code)
Dxe >O zo 01
For Privacy Act Reduction Act Notice, see separate instructions. cat. No. 16055N rorm SS-4 6ev
 PAR 121- FEtN Assignment

The attorney you work for recently asked you to sit in on a

meeting with a new client, patty
Jones, a sole proprietor whose business is growing and has
recently hired 3 new employees.
ln this meeting, you learned the following:

o PattV designs and sells one-of_a_kind backpacks.

o She's been doing this since January I,2oos as a sole proprietor,
operating under the
assumed name of pattyspacks out of her home.
o As of July 1, 2008, she has been making and selling her backpacks
from a small retail
store that she leases atr23 Main street, unit 12, chicago, lL 60600.
o Her fiscal year is January 1 through December 31.
o As of July I,2oO8, she has 3 employees who will each earn a starting salary of
Ssooo/year.
o Each employee will be paid on the l-5th and 30th of each month, with the 1't paychecks
having been delivered on 7/LS/2OO8..
o Because Patty now has employees, your attorney advises her that
she needs to apply to
the lnternal Revenue Service for an employer identification number (ElN).
o PattY will continue
to be a sole proprietor (Patty Joners, d/b/a pattyspacks this is the
-
entity for whom the FE|N is being requested.)
o Patty's social security number is 123_45_67g9.

Your boss has asked you to prepare the Application for Employer ldentification
Number.

ln order to do this, you should locate the form on the IRS website and complete
it directly
online, with Patty's signature.