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Home My WebLink AboutIBR1Form IBR-1 Business Registration Form orm Register online at: business.idaho-gov/forms Fax to: (208) 334-5364 IDAHO BUSINESS REGISTRATION Return to: PO BOX 36 BOISE, ID 83722-0410 1. Type of business (see instructions) SHADED AREAS FOR STATE USE ONLY Account Number I Confirmation No. Corporation Partnership _ S Corporation Sole Proprietorship Nonprofit Government _ Fiduciary/Trust _ Limited Liability Company Revised 2019 1 a. If LLC, how have you chosen to be taxed for income tax purposes? ❑ Single Member ❑ Corporation ❑ Partnership S Corporation r puse or registration New applicant _ Change legal name _ Change assumed business name (DBA) _ Add new account type _ Add/change location _ Change in partners, shareholders or managing members /o 3. Apply for permits/accounts Boise Auditorium Idaho Falls Auditorium Pocatello/Chubbuck Auditorium _ E911 Prepaid Wireless Fee Sales _ Marketplace Facilitator _ Out -of -State Retailer Use _ Travel & Convention Unemployment Withholding _ Withholding only, no employees working in Idaho Request more information Amusement Device _ Beer/Wine _ Cigarette/Tobacco 4. reaerai tmpioyer Identification Number (EIN) 47-22000827 7. Assumed business name (DBA) Filed with Sec of State Idahome Loans, LLC 11. Date business began in Idaho 01/15/2021 Social Security number (SSN) 6. Legal business name (see instructions) Name on SSN card for Sole Prop 8. Date incorporated 01/01/2015 12. Date sales or use will begin in Idaho 9. State incorporated in N 10. Month tax year ends December 13. Estimated monthly taxable sales month 09 year 2021 14. Physical location of business if outside Idaho (no PO Box or mail drop addresses) Street address City State County ZIP Code 15. Required: Physical location of Idaho employees or the lodging facility address (no PO Box or mail drop addresses) Street address City State County ZIP Code 2504 N. Snow Goose Way I Meridian I ID I ADA 83646 io. iviauing address Street address or PO Box City 2504 N Snow Goose Way I Meridian State County ZIP Code ID I ADA 83646 i r. iwaning Tor Idaho State Tax Commission forms Street address or PO Box City State County ZIP Code 2504 N Snow Goose Way Meridian ID Ada 83646 18. Business telephone number 19. Business contact person (name, title, and email) (See instructions for definitions.) POA will be required. ( 208 ) 867-6422 Kevin Parker President boiseidahomeloans@gmail.com 20. Telephone number & &extension of authorized contact person 21. Email address of authorized contact person 22. Fax number of authorized contact ( 208 ) 867-6422 kevinboiseidahomes@gmail.com person( ) 23. Primary nature of business: (Specify the product manufactured and/or sold or the type of service performed.) Firearms Sales EF000147 05-09-2019 Page 1 of 3 T Form IBR-1 Business Registration Form Revised 2019 24. Have you ever had a withholding, sales, use, workers' compensation or unemployment insurance number in Idaho? If yes, list all permit, account or policy numbers. (It is your responsibility to cancel any existing accounts you no longer need. Failure to provide previous account/policy numbers could result in delays and/or duplicate accounts.) 25. Are you a Professional Employer Organization (PEO)?.................................................................... Yes No If Yes, Name 26. If Yes, are you a Certified PEO?........................................................................................................ Yes ❑ No 27. Are you an employer joining a Professional Employer Organization? ............................................... Yes No Name of PEO 28. Are you an employer leaving a Professional Employer Organization? ........................................... _ Yes No Name of PEO 29. Are you a Common Paymaster? .............. ............................................... __..................................... ❑ Yes ONo If Yes, Name 30. Are you an employerjoining a Common Paymaster?......................................................... Name of Common Paymaster 31. Are you an employer leaving a Common Paymaster? ................ _........................ .......... .... Name of Common Paymaster .......... Yes ❑ No ......... ®Yes F-]No 32. Are you a IRS 3504 Pay Agent?......................................................................................................... Yes ❑ No If Yes, Name 33. Are you an employer joining a IRS 3504 Pay Agent?.......................................................... Name of Common IRS 3504 Pay Agent 34. Are you an employer leaving a IRS 3504 Pay Agent?......................................................... Name of Common IRS 3504 Pay Agent ....... Yes No Yes No 35. List (a) owner and spouse of sole proprietorship, (b) all partners of partnership, (c) all corporate officers of corporation, (d) trustee or responsible party of fiduciary or trust, or (e) all members of limited liability companies. Social Security number required for every individual listed. (Use additional sheet if necessary.) Name Address of Residence SSN/EIN, Phone Number and Email Corp Title % Director? Compensated Owned Yes/No Yes/No KEVIN S. PARKER 2504 N SNOW GOOSE 518-88-7618 100 select Yes Officer Shareholder WAY, MERIDIAN ID 83646 PRESIDENT select I select Officer Shareholder select I select Officer Shareholder CERTIFICATION: I certify that I am authorized as an owner, partner, corporate officer member or representative to sign this document and that the statements made are correct and true to the best of my knowledge. (This f musral-77n=the of a sole proprietor.) Print name KEVIN S. PARKER Sign c ate 08/12/2021 Print name Signature Date EF000147 05-09-2019 Page 2 of 3 I Form IBR-1 Business Registration Form Revised 2019 36. Date employees first hired to work in Idaho 37. Date of employees' first paycheck in Idaho 38. Expected number of Idaho employees NONE (Include corporate officers working in Idaho) 39. Enter the amount of wages you have paid or estimate to pay in Idaho. If you haven't paid or don't plan to pay wages during one of the periods listed, enter "NONE." Jan. 1 to March 31 April 1 to June 30 July 1 to Sept. 30 Oct. 1 to Dec. 31 Current Year Preceding Year AOIf .,.,, ....+7..,...a., .+...---- °_ .,..,. .. -- -- - �� —tl — —, V11«I LlI" uare you pran to begin paying wages. 41. Will corporate officers receive compensation, salary or distribution of profits?17-11 Yes ❑ No 42. Is this an organization exempt from income tax under Internal Revenue Service Code 501(c)(3)? 43. Is workers' compensation insurance needed? (see instructions) Yes No, explain why: CAUTION: This is not an application for workers' compensation insurance 44. Do you have a workers' compensation 45. Have you notified your insurance company that insurance policy? you have or expect to have Idaho payroll? Yes No In process 47. Insurance company name 48. Policy number Yes No E]Yes QNo 46. Insurance agent's name and telephone number 49. Effective date I 50. If applying for insurance with the Idaho State Insurance Fund, list application number: 51. Do you plan to perform work in other states using your existing Idaho employees? If Yes, will you withhold Idaho Income Tax? Select ❑Yes Q No ACQUIRING AN EXISTING BUSINESS OR CHANGING TYPE OF LEGAL BUSINESS ENTITY If you buy an existing business, or change your business entity, Idaho law requires you to withhold enough of the purchase money to pay any sales tax and, in most cases, unemployment insurance due or unpaid by the previous owner/entity until the previous owner/entity produces a receipt from the Idaho Department of Labor and the Idaho State Tax Commission showing the taxes have been paid. If you fail to withhold the required purchase money and the taxes remain due and unpaid after the business is sold or converted to another entity type, you may be liable for the payment of the taxes collected or unpaid by the former owner/entity. When there is a change in the legal entity, you must notify your workers' compensation insurance company. u yuu crcquue an or part of an existing business? 153. Did you change your legal business entity? All Part None I Yes No . lumius uwner s name 55. Business name at time of purchase 56. Date acquired/changed 57. Account/permit numbers of the business acquired/changed PUBLICATION CONSENT oa. was there a change in owners, members, or partners? Yes No If Yes, are any of the former owners, members, or partners still operating/managing the business for the new owner(s)? Yes No If No, is the owner of the new business ALSO a former employee of the old business who had authority to make financial or hiring/firing decisions? Yes ❑ No 59. Yes, I agree to publish my business by category both in print and on the Internet in the Business Director of Idaho at Iml.idaho.gov and any publication produced by the Idaho Department of Labor. This will increase visibility of my business to a larger pool of job applicants, will allow my business to be included when the Department of Labor responds to questions about the availability of products and services in the community, and expand the opportunity for additional sales. I acknowledge the Idaho Department of Labor's files will be accessed to obtain my company name, address, phone number, NAICS (industry) code and range of employment. Signature EF0O0147 05-09-2019 Page 3 of 3