Form B 104 PDF Details

If you're like many small business owners, you may be wondering what Form B 104 is and whether or not you need to file it. This form is used to report the amount of money a business pays in New Jersey state taxes. Generally, businesses with income of more than $50,000 per year must file this form. However, there are some exceptions, so it's best to speak with an accountant or tax specialist to determine if you need to file Form B 104. Failing to submit this form can result in hefty fines, so it's important to take care of this requirement if applicable.

QuestionAnswer
Form NameForm B 104
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesFD, DVM, Ghanian, washington state birth certificate form

Form Preview Example

BIRTH RECORD

FATHER’S INFORMATION

Page 1 of 2

Mother’s Name:

Mother’s Date of Birth:

Medical Record Number:

Father’s Information: Please Print Clearly

What is your current legal name?

First Name

 

 

Middle Name

 

Last Name

Suffix

What is your mailing address (if different from the mother)?

 

Same as the mother's address

 

 

 

 

 

 

 

 

 

 

Number and Street address, P.O. Box or Rural Route numbers

 

 

Apartment Number

 

 

 

 

 

 

 

 

 

 

 

 

City or Town

State

 

Zip Code

If not United States, please enter country.

What is your date of birth?

MMDD YYYY

Where were you born?

City or Town

State or Foreign Country

What is your social security number?

I don’t have a Social Security number.

Form # B 104

01/01/2010

BIRTH RECORD

FATHER’S INFORMATION

Page 2 of 2

What is your highest level of education?

Mother’s Name:

Mother’s Date of Birth:

Medical Record Number:

Check the box that best describes your highest level of school completed at the time of your child’s birth.

8th grade or less

9th – 12th grade, no diploma

High school graduate or GED completed Some college credit but no degree Associate degree (AA, AS)

Bachelor’s degree (BA, AB, BS)

Master’s degree (MA, MS, MEng, Med, MSW, MBA)

Doctorate degree ( PhD, EdD, MD, DDS, DVM, LLB, JD)

ARE YOU SPANISH/HISPANIC/LATINO? If you are not Spanish/Hispanic/Latina, check the "NO" box. If you are, check the box that is most appropriate for you.

No, not Spanish/Hispanic/Latino

Yes, Spanish/Hispanic/Latino

Mexican, Mexican American, Chicano

Puerto Rican

Cuban

Other Spanish/Hispanic/Latino PLEASE SPECIFY:

FATHER’S RACE: Check all that apply to indicate what you consider yourself.

Caucasian (white)

 

 

Asian

Black or African American

 

 

Asian Indian

Somali

 

 

Chinese

Ethiopian

 

 

Filipino

Liberian

 

 

Japanese

Ghanian

 

 

Korean

Kenyan

 

 

Vietnamese

 

 

 

 

 

 

Sudanese

 

 

Hmong

 

 

 

 

 

 

Nigerian

 

 

Cambodian

 

 

 

 

 

 

Other African

 

 

Laotian

 

 

 

 

 

 

PLEASE SPECIFY:

 

 

Other Asian

 

 

 

 

 

 

PLEASE SPECIFY:

American Indian or Alaska Native

 

 

Other Race

Name of Enrolled or Principal Tribe

 

 

PLEASE SPECIFY:

PLEASE SPECIFY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pacific Islander

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

PLEASE SPECIFY:

Form # B 104

01/01/2010

FETAL DEATH REPORT

FATHER’S INFORMATION

Page 1 of 2

Father’s Information: Please Print Clearly

What is your current legal name?

Mother’s Name:

Mother’s Date of Birth:

Medical Record Number:

First Name

Middle Name

Last Name

Suffix

What is your mailing address (if different from the mother)?

Number and Street address, P.O. Box or Rural Route numbers

Apartment Number

 

 

 

 

 

 

 

City or Town

State

Zip Code

 

 

 

 

 

 

If not United States, please enter country.

 

 

 

What is your date of birth?

MMDD YYYY

Where were you born?

City or Town

What is your social security number?

State or Foreign Country

I don’t have a Social Security number.

Form # FD 104

01/01/2010

FETAL DEATH REPORT

FATHER’S INFORMATION

Page 2 of 2

What is your highest level of education?

Mother’s Name:

Mother’s Date of Birth:

Medical Record Number:

Check the box that best describes your highest level of school completed at the time of your child’s birth.

8th grade or less

9th – 12th grade, no diploma

High school graduate or GED completed Some college credit but no degree Associate degree (AA, AS)

Bachelor’s degree (BA, AB, BS)

Master’s degree (MA, MS, MEng, Med, MSW, MBA)

Doctorate degree ( PhD, EdD, MD, DDS, DVM, LLB, JD)

ARE YOU SPANISH/HISPANIC/LATINO? If you are not Spanish/Hispanic/Latina, check the "NO" box. If you are, check the box that is most appropriate for you.

No, not Spanish/Hispanic/Latino

Yes, Spanish/Hispanic/Latino

Mexican, Mexican American, Chicano

Puerto Rican

Cuban

Other Spanish/Hispanic/Latino PLEASE SPECIFY:

FATHER’S RACE: Check all that apply to indicate what you consider yourself.

Caucasian (white)

 

 

Asian

Black or African American

 

 

Asian Indian

Somali

 

 

Chinese

Ethiopian

 

 

Filipino

Liberian

 

 

Japanese

Ghanian

 

 

Korean

Kenyan

 

 

Vietnamese

 

 

 

 

 

 

Sudanese

 

 

Hmong

 

 

 

 

 

 

Nigerian

 

 

Cambodian

 

 

 

 

 

 

Other African

 

 

Laotian

 

 

 

 

 

 

PLEASE SPECIFY:

 

 

Other Asian

 

 

 

 

 

 

PLEASE SPECIFY:

American Indian or Alaska Native

 

 

Other Race

Name of Enrolled or Principal Tribe

 

 

PLEASE SPECIFY:

PLEASE SPECIFY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pacific Islander

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

PLEASE SPECIFY:

Form # FD 104

01/01/2010