New Resident Incometax Questionnaire Form printable pdf download

NEW RESIDENT FORM

Welcome to the Village of Walbridge

Income Tax Questionnaire

The information requested on this form is essential to the completion of our tax records and will be held in

strict confidence. Please print or type and return this form to the tax office. Please use the enclosed envelope

and return the questionnaire within 10 days.

Date moved to Walbridge: ______________________

Name: ___________________________________ Social Security No: _______________________

Address: _________________________________________________________

Spouse Name: _____________________________ Social Security No: _______________________

Employers Name: ________________________________________________________

Employers Address: ______________________________________________________

Spouse’s Employer: _________________________________________________________

Spouse’s Employer Address: __________________________________________________

1) Is your city or village income tax withheld in another municipality? Yes ___ No ___

2) Would you like us to send you a quarterly tax payment form? Yes___ No ___

3) If you are not currently employed, please indicate your present status:

Laid Off: ____ Unemployed: ____ Retired: ____ Other: ______________________

4) Are you self employed? No _____ Yes ________ If yes, what is the nature of your business?

__________________________ Name of business: __________________________________

5) Do you have rental income? Yes ____ No ____

6) Do you have any other source of income? Yes ____ No ___ If yes please list the source below

_______________________________________________________________________________

7) Is there any other persons living at this address? Yes ___ No ___ if yes, please provide the following

information.

Name: _________________________________ Social Security No: ___________________________

Is this person employed? Yes __ No ___ If no, what is their source of income? ___________________

If yes, please provide information below.

Employers Name: _________________________________

Employers Address: _______________________________

Is city or village tax withheld in another municipality? Yes ___ No ___

Would you like us to send you a quarterly tax payment form? Yes___ No ___

If additional space is needed please use the back of this form

I, ____________________________ hereby certify that the information provided above is true and

accurate to the best of my knowledge.

Signature: _____________________________ Date: _____________________

This form must be returned to Village of Walbridge 111 N. Main St Walbridge Ohio 43465 within 10 days.

New Resident Incometax Questionnaire Form