Individual Questionnaire - City Of Hamilton
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1
2INDIVIDUAL QUESTIONNAIRE
Phone:
513 785-7400
CITY OF HAMILTON
Toll Free: 1 800 854-1684
*HAMILTON – 2%
CHECK APPROPRIATE CITY
EATON – 1.5%
INCOME TAX DIVISION
Fax:
513 785-7401
*WEST MILTON – 1.5%
NEW MIAMI – 1.75%
345 High Street, Suite 410
Email:
citytax@ci.hamilton.oh.us
Hamilton, Ohio 45011
Website:
*PHILLIPSBURG – 1.5%
USE A SEPARATE FORM FOR EACH CITY
BUTLER COUNTY ANNEX -
2%
Please answer the questions fully and fax or mail this questionnaire to the Income Tax Division within ten (10) business days.
NAME _________________________________________________________________
PHONE NO. __________________________________
ADDRESS ____________________________________________________________________________________________________________
DATE MOVED INTO THE ENTITY CHECKED AT THE TOP OF THIS FORM _______________________________________________________
SOCIAL SECURITY # ____________________________________
EMAIL _____________________________________________________
Please list your previous addresses from most recent to oldest.
Address
Date Moved In
Date Moved Out
1.
2.
3.
4.
5.
Please list starting
TAXPAYER
If paying city taxes,
Name of Employer
and ending dates of
please list city being
Please list address where you perform work for this
employment for each
(Begin with present or the most recent)
employer
employer
paid or withheld
1.
2.
3.
If you are self-employed, describe the nature of your work and list the years in which you were self-employed.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
SPOUSE’S NAME _______________________________________________________
PHONE NO. __________________________________
ADDRESS ____________________________________________________________________________________________________________
DATE MOVED INTO THE CITY CHECKED AT THE TOP OF THIS FORM __________________________________________________________
SOCIAL SECURITY # ____________________________________
EMAIL _____________________________________________________
Please list starting
SPOUSE
If paying city taxes,
Name of Employer
and ending dates of
please list city being
Please list address where you perform work for this
employment for each
(Begin with present or the most recent)
employer
employer
paid or withheld
1.
2.
3.
~Continue~
If you are self-employed, describe the nature of your work and list the years in which you were self-employed.
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