Business And Professional Questionnaire Form
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Return Within 15 Days
BUSINESS AND PROFESSIONAL QUESTIONNAIRE
For the purpose of our records, with regard to City of Moraine income tax, please complete and return this questionnaire promptly to the address
below.
Date Business began in Moraine: ____________________________
Contact Name: __________________________________
Company Name/ DBA: _____________________________________
Contact Title: ____________________________________
Local Address: ___________________________________________
Contact Number:_________________________________
City/State/Zip: ____________________________________________
Contact Email: ___________________________________
(If different than local information)
Corporate Name: _________________________________________
Calendar/ Fiscal Year End Date: _____________________
Corporate Address: ______________________________________
SSN # / Federal ID Number: _________________________
City/State/Zip: ____________________________________________
Nature of Business: _______________________________
Please check type of ownership:
Sole Proprietorship
Partnership
Corporation
City of Moraine income taxes due on net profit
Type of Corporation:
earnings will be filed: (Please check one)
_____ Limited Liability
_____ In full by the business
Separately by owners on their personal income tax
_____ S Corp
_____
return.
List owner’s SSN# and address on the back of
_____ C Corp
this form for account set-up.
_____ Nonprofit Corporation
Other (Please state type of ownership below)
_____ Other ________________________
Address to which tax forms are to be mailed:
Net Profit:
Withholdings:
(Quarterly Estimates are Required.)
(Quarterly filing threshold is $100 or less a month.)
Check here if same as location address above
Check here if same as location address above
Check here if a payroll service will report.
Employees:
Residential Businesses Only:
How many people do you employ/lease who work in the City of
Do you rent or own the building in which your business is
Moraine? Local Address:_____________________________
conducted?
Own
If you answered 0 to the previous question, do you plan to have
Yes / No
Rent
employees in the City of Moraine in the future?
Landlord's name: _______________________
Are you withholding a residential/courtesy income tax from any
Business Address: ______________________
of your employees that live in Moraine?
Yes / No
Date Began:___________
*** Make sure you check with our Community Development Department at (937) 535-1030 for any/all permit
requirements you may have for occupancy/work performed within the City of Moraine. ***
Any person violating any of the provisions of Chapter 181, Income Tax, City of Moraine Codified Ordinances, shall be punishable as provided in Section
181.12. Failure to file the required forms and/or failure to pay the Income Tax constitutes a violation of this chapter.
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