Form Busq/2014 - Business & Professional Questionnaire Form - City Of Canfield Income Tax Department
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2BUSINESS & PROFESSIONAL QUESTIONNAIRE
CITY OF CANFIELD INCOME TAX DEPARTMENT, 104 LISBON STREET, CANFIELD, OHIO 44406-1416
Phone: 330-533-1101 ~ Fax: 330-533-2668 ~ Web-site:
~ E-mail:
vshook@ci.canfield.oh.us
Name:
DATE:
Per Ordinance 183.03 the imposition of one percent tax on all salaries, gross wages, commissions, tips, gratuities, and other
compensation earned by resident or non-resident. To establish and maintain accurate records, the Income Tax Ordinance requires that
you complete and return this form within ten days.
FAILURE TO COMPLY WITH THE REQUIREMENTS OF PROVIDING THIS INFORMATION TO THE CITY AS REQUIRED
CODIFIED ORDINANCE 183.03 IS A VIOLATION OF THE LAW PUNISHABLE BY A FINE OF UP TO $1,000.00 PER ORDINANCE
183.99.
PLEASE PRINT.
1. Federal I.D. No. ____________________________
2. Soc. Sec. No. _______________________________
3. Local name & address as used for business purposes: Trade Name ______________________________________
Location _____________________________________________________
4. Phone # ____________________
5. Fax # _______________ 6. E-mail address _______________________________________________________
7. Nature of business_________________________________ 8. Date property purchased _______________
9. Date business moved to or opened in City _______________
10. Date began work in the City _______________
11. Accounting period for Federal Tax: ___ Calendar Year ending Dec. 31 ___ Fiscal Year ending _________________
12. Do you employ one or more persons? ____ 13. Will you WH $100.00 or more monthly in Canfield income tax? ___
14. Do you employ persons from whom no Canfield City tax is withheld? _____ If Yes, attach a list with name, address,
and SSN of each person. 15. If a payroll service is used please give name of service, contact person and phone
number. __________________________________________________________________________________
16. Type of ownership: ____ Individual Proprietorship
____ Corporation
____ S Corp
____ Partnership
___ LLC
____ Non-Profit Corporation
____ Other: ________________________________
17. If partnership, association, or other unincorporated joint business venture, not located in the City limits, how will the
Canfield Net Profit Tax Return be filed? ___ In full by business. ___ Separately by individual partners on their
proportionate shares (list partners on page 2, #16). The pass through entity must file if located in City.
18. Send Business Net Profit Form to:
Send Withholding Forms To:
Name ________________________________________ Name ________________________________________
Care of _______________________________________ Care of _______________________________________
Address ______________________________________ Address ______________________________________
City __________________ State ____ ZIP ___________ City __________________ State ___ ZIP ___________
Phone ____________________
Phone ____________________
19. Owner's name and address:
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