Business Registration Application Form - City Of Ashtabula
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1Trisha L. Patton
Income Tax Specialist
CITY OF ASHTABULA
440.992.7104
email:
INCOME TAX DEPARTMENT
City Municipal Building
Mariangeli Montalvo
P.O. Box 601 Ashtabula, Ohio 44005
Website:
Finance Clerk
Phone: 440.992.7104
440.992.7104
email:
FAX:
440.992.7556
BUSINESS REGISTRATION APPLICATION
For the purpose of our records, with regard to Ashtabula Income Tax, PLEASE COMPLETE AND RETURN IN 10 DAYS.
Complete all required information. If you have any questions, please call our office.
Firm Name : ___________________________________________________________________________________________
Doing Business As (DBA) ____________________________________________Fiscal Year End Date: ___________________
Local Street Address of Business: ___________________________________________________________________________
City: ______________________________________ State: _________________ ZIP: _________________________________
Mailing Address: _________________________________________________________________________________________
Is this the Home Office? ___ Branch Office ___
Telephone Number: (___) ____-______ Contact Person: ______________________ Business Product/Service:______________
Email:__________________________________________________________________________________________________
JEDD ACCOUNT? ___YES ___NO
Date Began Doing Business in (Please check one): ___ Ashtabula City ___ Ashtabula Township ___ Saybrook Township
Date: _____________ and/or Employee Withholding: _______________
Federal Id Number: __________________________ or Social Security Number, if sole proprietorship: _____________________
Number of Employees: ________ If none, do you expect to have employees in the future? ___YES ___NO
Type of Business (Please Check one): ___ Corporation ___ S-Corporation ___ Partnership ___ Sole Proprietorship
___ LLC (single member) ___ LLC (multiple members) ___ LLP
Filing Payroll Taxes (Please check one): ___ Monthly ___ Quarterly
Will a payroll company be filing the company’s withholding taxes? (Please check one):
___ Yes, name of the Payroll Company ____________________________________________________________
___ No
Does your company lease employees? (Please check one):
___ Yes, name of leasing company _______________________________________________________________
___ No
Does your company use subcontractors? (Please check one):
___ Yes, attach a list with name, address and phone numbers of subcontractor(s)
___ No
If the company is replacing another company previously registered with us (e.g. due to incorporation, mergers, etc…),
please indicate the name and FID number of the company: _______________________________________________________
Name and Address of Corporate Officers or Partners (or attach list): _________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Is this a courtesy withholding? ___Yes ___NO If withholding for ONE individual, please provide the name and address below.
________________________________________________________________________________________________________
SIGNATURE _____________________________________ DATE ___________________________________________________________
(For Tax Office Only)
CITY FILE NO.________________
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