Business Questionnaire - City Of Dublin Division Of Taxation
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1
2CITY OF DUBLIN
Division of Taxation
BUSINESS QUESTIONNAIRE
The information requested on this form is essential to the establishment of your account and will be used for
official purposes only. Please complete and sign this Questionnaire and return within 15 days. If you have any
questions, contact the Division of Taxation at (614) 410-4460 or 1-888-490-8154.
Type of Organization: (Please check one)
Federal I.D. No. _______________________
Corporation
Partnership
Non-Profit
Social Security No. _____________________
Sole Proprietor
LLC
1. Local name and address as used for business purposes:
Business name:
____________________________________________________________________________
Address:
____________________________________________________________________________
City/State/Zip:
____________________________________________________________________________
Telephone No.
(
) ____________________
Fax No. (
) ____________________
2. Description of your primary product or service: ________________________________________________
NAICS Code: ________________________________________________
3. What date did your operation begin in Dublin? ________________________________________________
4. If corporate subsidiary, give name and address of parent company main office:
Name:
________________________________________________
Address:
________________________________________________
City/State/Zip:
________________________________________________
5. If Sole proprietorship, give owner's name and address
Name:
________________________________________________
Address:
________________________________________________
City/State/Zip:
________________________________________________
6. Name and title of your Chief Executive Officer: ________________________________________________
7. Please list all names, addresses, and telephone numbers of all partners or principal corporate officers: (attach
list if necessary)
Name
Address
Telephone Number
(a) ___________________________________________________________________________________________
(b) ___________________________________________________________________________________________
(c) ___________________________________________________________________________________________
8. Accounting period used:
Calendar year ending December 31
Fiscal year ending: ____________
PLEASE COMPLETE QUESTIONS ON REVERSE SIDE
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