Individual Tax Questionnaire Form - City Of Huber Heights
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City of Huber Heights
Division of Taxation
P. O. Box 24309
Huber Heights, Ohio 45424
Phone: (937) 237-2976
Fax: (937) 237-2983
INDIVIDUAL - INCOME TAX QUESTIONNAIRE
Huber Heights has a mandatory filing requirement for all residents.
Acct:#_______________
Taxpayer Information (Please type or print)
(Office Use Only)
Name __ ________________________________________________________ Social Security _____/____/______
DOB ____/____/____ Home Telephone # (_____) ______________Work Telephone # (_____)________________
Current Address _______________________________ City ________________State _________ Zip __________
Date Moved to Current Address _____/____/______
Email Address_________________________________________________________________________________
Employer _____________________________________________________________________________________
Employer Address ______________________________________________________________________________
Employment Date ____/____/____City tax withhold ? No ____ Yes ____, for the City of ____________________
Self Employed Business Name _______________________Type of Business_______________________________
Business Address ______________________________________________ Date Business started ____/____/____
Do you have employees? No ____ Yes ____, If YES, your Federal ID# __________________________________
*********************************************************************************************
Spouse Information
Name ___________________________________________________________ Social Security _____/____/______
DOB ____/____/____ Home Telephone # (_____) _______________Work Telephone # (_____)_____________
Employer _____________________________________________________________________________________
Employer Address ______________________________________________________________________________
Employment Date ____/____/____City tax withhold? No ____ Yes ____, for the City of ______________________
PLEASE COMPLETE PAGE 2
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Parent category: Financial