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Primary Holder Info section header
Primary Holder Info
Please enter the following information:
*
Holder Name
:
*
Holder Tax ID
:
*
Holder ID
:
*
Incorporated States
:
AA-APO
AE-APO
Alabama
Alaska
American Samoa
AP-APO
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Minor Outlying Islands
Utah
Vermont
Virginia
U.S. Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
*
Incorporated Date
:
Date of Birth MM
MM
1
2
3
4
5
6
7
8
9
10
11
12
Date of Birth DD
DD
1
2
3
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20
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22
23
24
25
26
27
28
29
30
31
Date of Birth YYYY
YYYY
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
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1996
1995
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1992
1991
1990
1989
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1987
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1982
1981
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1978
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1963
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1961
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1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
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1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
*
NAICS Code Charter
:
*
Holder Address 1
:
*
Holder Address 2
:
*
Holder Address 3
:
*
Holder City
:
*
Holder State
:
- Select an Option -
AA-APO
AE-APO
Alabama
Alaska
American Samoa
AP-APO
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Minor Outlying Islands
Utah
Vermont
Virginia
U.S. Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
*
Holder Zip
:
*
Contact Name
:
*
Contact Phone Number
:
*
Phone Extension
:
*
Email Address
:
*
Email Address Confirmation
:
Report Info section header
Report Info
Please enter the following information:
*
Report Type
:
Annual Report
Supplemental Report
Revised Report
Safekeeping Report
Lawyer Trust Report
Audit Report
Reciprocal Report
Voluntary Disclosure Agreement
Negative Report
*
State
:
- Select an Option -
AA-APO
AE-APO
Alabama
Alaska
American Samoa
AP-APO
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
U.S. Minor Outlying Islands
Utah
Vermont
Virginia
U.S. Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
*
Report Year
:
- Select an Option -
2019
2020
2021
2022
2023
2024
*
This is a Negative Report
:
?
Yes
No
?
*
Total Dollar Amount Remitted
:
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