Business Tax Questionnaire Form Page 2
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1
210.
Do you: Own ______
Rent ______
Lease ______ your place of business in Kettering?
If you rent or lease, complete the following: (Please include name and address of business, person, etc. from
whom you rent or lease.)
Name
Address
11.
Are you currently filing a City Income Tax Return?
Yes ______
No ______
What city (or cities)
12.
If you filed under a different name and/or identification number previously, indicate name, address,
identification number and year(s) filed.
13.
Did you file a City of Kettering Income Tax Return last year? Yes ______
No ______
14.
Have you been audited by the Internal Revenue Service within the last three years? Yes _____ No _____
If yes, what tax years?
15.
If there has been a change of ownership, give name and address of former owner and date of change in
ownership
16.
Address to which tax forms are to be mailed:
Annual Income Tax Return and Estimated
Payment Vouchers:
Withholding Tax Forms:
Name
Name
Attention:
Attention:
Street Address
Street Address
City
State
City
State
Zip
Zip
Phone
Phone
I hereby certify that information and statements contained herein are true and correct.
Name
Signature
(please print)
Title
Phone
Date
tx-3001-tj.doc (Rev. 1/17/02)
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Parent category: Financial