Beneficial Ownership Information Reporting

Information Submission Form for Entities Created Prior to January 1, 2024 Filing Initial Reports

Thank you for choosing Battaglia Law, PLLC to assist you with the filing of your Beneficial Ownership Information (“BOI”) Report with the Financial Crimes Enforcement Network (“FinCen”). To ensure a smooth and efficient filing process, please complete the following information. This form will collect the necessary details for us to accurately file your BOI report with FinCEN.

Who is a Beneficial Owner?

For purposes of BOI reporting, a “beneficial owner” is an individual who either directly or indirectly: (1) exercises substantial control over a reporting company, or (2) owns or controls at least 25 percent of a reporting company’s ownership interests. An individual can exercise substantial control over a reporting company in four different ways. If the individual falls into any of the categories below, the individual is exercising substantial control:

The individual is a senior officer (the company’s president, chief financial officer, general counsel, chief executive office, chief operating officer, or any other officer who performs a similar function).
The individual has authority to appoint or remove certain officers or a majority of directors (or similar body) of the reporting company.
The individual is an important decision-maker for the reporting company.
The individual has any other form of substantial control over the reporting company as explained further in FinCEN’s Small Entity Compliance Guide.

Beneficial Ownership Information | FinCEN.gov

FinCEN has prepared the following Frequently Asked Questions (FAQs) in response to inquiries received relating to the Beneficial Ownership Information Reporting Rule and Beneficial Ownership Information Access and Safeguards Rule.

Go to link

https://fincen.gov/boi-faqs

BOI Information Form

If you have any questions or require further assistance while you are completing the form, please do not hesitate to contact our office.

**Information for Person Submitting Form**

**Company Information**

Entity’s Legal Name (“Entity”)

Does the Entity use any alternate names such as a DBA or a trade name?

Tax Identification Number

Entity Address

Was the Entity created prior to January 1, 2024?
YesNo

**Beneficial Owner(s) Information**

Beneficial Owner #1 Information

Legal Name of Beneficial Owner #1

Owner #1 Date of Birth

Owner #1 Address

Please upload a legible copy/image of Owner #1’s identification, which can be any of the following:
– State issued driver’s license
– State/local/tribe issued identification card
– United States Passport
*required

Are there any other Beneficial Owners beyond Owner 1?
YesNo

Beneficial Owner #2 Information

Legal Name of Beneficial Owner #2

Owner # 2 Date of Birth

Owner #2 Address

Please upload a legible copy/image of Owner #2’s identification, which can be any of the following:
– State issued driver’s license
– State/local/tribe issued identification card
– United States Passport
*required

Are there any other Beneficial Owners beyond Owners #1 & 2?
YesNo

Beneficial Owner #3 Information

Owner #3 Date of Birth

Owner #3 Address

Please upload a legible copy/image of Owner #3’s identification, which can be any of the following:
– State issued driver’s license
– State/local/tribe issued identification card
– United States Passport
*required

Any other info you wish to provide?

We will be notified when you submit the information by clicking the button below. If we are in need of any additional information, we will follow up with you. Otherwise, we will file the BOI report based upon the information you provide.

I hereby authorize Battaglia Law, PLLC to file a BOI Report with FinCen on behalf of the reporting company entity named herein. I further certify, on behalf of the reporting company, that the information contained herein is true, correct, and complete.

Beneficial Ownership Information Reporting

Information Submission Form for Entities Created Prior to January 1, 2024 Filing Initial Reports

Who is a Beneficial Owner?

BOI Information Form

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