Business Questionnaire Form Page 2
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26.
IF PARTNERSHIP, ASSOCIATION, JOINT VENTURE, OR SMALL BUSINESS CORPORATION, LIST
NAMES AND ADDRESSES OF PARTNERS, ASSOCIATES, OR MEMBERS IN VENTURE.
a.
NAME
ADDRESS
CITY,
STATE
(1)_____________________
_________________________
_________________________
(2)_____________________
_________________________
_________________________
(3)_____________________
_________________________
_________________________
(4)_____________________
_________________________
_________________________
(5)_____________________
_________________________
_________________________
(6)_____________________
_________________________
_________________________
7.
DO YOU OPERATE ANY OTHER BUSINESS WITHIN OR OUTSIDE OF MANTUA VILLAGE
WHICH IS SUBJECT TO VILLAGE OF MANTUA INCOME TAX?
a. TRADE NAME ADDRESS
NATURE OF BUSINESS
ACCOUNT NO.
(1)____________________________________________________________________________________
(2)____________________________________________________________________________________
(3)____________________________________________________________________________________
(4)____________________________________________________________________________________
8.
WHEN DID YOUR BUSINESS, COVERED BY THIS QUESTIONNAIRE, BEGIN THE PRESENT
OCCUPANCY OF PROPERTY LOCATED IN MANTUA VILLAGE?
a.
Date ______________________
If known, please list name of prior occupant of this property.
Name __________________________________________________________________
Address _________________________________________________________________
9.
USE THIS SPACE FOR ANY ADDITIONAL INFORMATION WITH REGARD TO YOUR BUSINESS
OPERATION FOR VILLAGE INCOME TAX PURPOSES.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
10.
The information hereby submitted, including any accompanying lists and statements, is true and correct:
Signature________________________________________
Date signed ______________
Business (or trade) name used _________________________
Your Phone No. ___________________ ext. _____
Address ______________________________ City ____________ State _____ Zip ______
Questionnaire prepared by: _________________________________
Address, city, state, zip ___________________________________
___________________________________
___________________________________
Signed _________________________ Title _________________
ATTACH ANY ADDITIONAL INFORMATION NECESSARY
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