Individual Tax Questionnaire Form - City Of Huber Heights Page 2
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2Spouse Information Continued
Self Employed Business Name ___________________________Type of Business___________________________
Business Address ______________________________________________ Date Business started ____/____/____
Do you have employees? No ____ Yes ____, If YES, your Federal ID# __________________________________
Previous Addresses
1. ________________________________ City ______________State __________ Date in ____/____out____/____
2.________________________________ City ______________State __________ Date in ____/____out____/____
Rental Property
Do you own Rental Property? Yes ____ No ____ If Yes, continue below.
Location of property [actual address(es)]
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Date acquired and/or date first rented ____/____
Use separate sheet for additional listings.
Other Income
Other Income, e.g. partnerships, commissions, fees, etc. List types:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Other Members of Household
Names and Social Security Numbers of other members of the household over age 18:
______________________________________________________SSN: _____/____/______ DOB ____/____/____
______________________________________________________SSN: _____/____/______ DOB ____/____/____
______________________________________________________SSN _____/____/______ DOB ____/____/____
If you are not liable for city tax, give reason
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Active Duty Military income and some types of retirement income are not taxable. You may still be required to file
a Return.
Signed ____________________________________________________________________ Date ____/____/____
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