Form 301-EF — Annual Withholding Reconciliation

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Form North Dakota Office of State Tax Commissioner 301-EF ACH Credit Authorization 1. Taxpayer Legal Name 2. Doing Business As Name (if different from line 1) 3. Mailing Address 4. City, State & Zip 6. E-Mail Address for Contact Person 8. State Withholding Account Number (Your 9-digit federal ID plus the State's 2-digit suffix) * Your 9-digit federal ID plus the State's 2-digit suffix Section 1 - Taxpayer Information Name of Payroll Service Mailing Address City, State & Zip Contact Person E-Mail Address for Contact Person Telephone Number for Contact Person Complete this section only if a payroll service will be making your payments or if you are a payroll service preparing this form for the taxpayer.[ ] This form does not provide on-line access to your withholding account information. For on-line access, please see instructions . By signing below, I understand I have requested permission to file withholding tax returns and remit payment electronically via an ACH credit transaction I must initiate through my bank. I have contacted my bank and confirmed the bank can initiate ACH credit transactions that meet the State's requirements. I understand the ACH c redit transaction must be in the NACHA standards format using the TXP convention to facilitate the proper posting of the credit. I agree to follow the instructions s et forth in the income tax withholding guideline and on the reverse side of this form. I also understand by completing the Payroll Service Information Section, I have designat ed the Payroll Service to act as my authorized representative in matters related to the filing of my withholding tax returns with the State, including the disclosure of confi dential withholding tax information on file with the State. Once I have been approved to file electronically using an ACH Credit, I will not receive a paper return from the St ate, and will be required to file and pay using the ACH credit method for each tax period. This authorization to participate is in effect until it is terminated by either par ty. Taxpayer's Signature: (Authorized Officer or Individual) Print Name: Date: Title: Note: If this form is being completed by a Payroll Service on behalf of the taxpayer, the taxpayer's authorized signature must be obtained for us to disclose information unless there is a Form 500 on file with our office. Mail to: Office of State Tax Commissioner Contact: Phone: 701-328-1241 Business Registration 600 E. Boulevard Ave. Dept. 127 Bi smarck, ND 58505-0599 Fax: 701-328-0332 E-mail: taxregistration@nd.gov Website: Section 2 - Payroll Service Information Section 3 - Taxpayer Signature

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5. Contact Person for E-File 7. Phone Number for Contact Person Please print. See reverse for instructions. New ACH Credit Change contact name/address Change payroll service information Income Tax Withholding Only

301-EF Instructions Employers must have an active income tax withholding account with the Office of State T ax Commissioner before filing electronically. Go to www.tax.nd.gov/tap and select Apply for Sales & Use or Withholding to obtain an account or to re-open an account. Two methods are available to file income tax withholding returns electronically: • Taxpayer Access Point (TAP) - Returns and payments are submitted online. TAP provides access to online features that allow authorized users to view previously filed returns and payments, upload or key W-2 information, change filing methods, and add or delete user's access. To register online go to www.tax.nd.gov/tap and sign up for access. • ACH Credit (Withholding E-File) - An ACH Credit is an electronic transfer of funds where you instruct your bank to transfer payment from your account to the state's bank account. The ACH Credit contains return information and, therefore, also serves as the return. Registration may be completed by submitting this paper form. Registration using this paper form does not provide you access to TAP to view previously filed returns. Tax Payment Banking (TXP) addenda record layout is required for Income T ax Withholding returns and is available at www.tax.nd.gov. Helpful Hints for the Form • Complete all questions to avoid any delay . • The E-File contact person should be the person who will actually be involved in initiating and making the electronic filing of your return. Be sure to include a phone number. • If you are a Payroll Service completing the application on behalf of a taxpayer, be sure to have the taxpayer sign and date the form at the bottom of Section 3. o Exception: If a properly completed Form 500 Authorization to Disclose Tax Information and Designation of Representative has been submitted by the taxpayer, no signature is required.