Taxpayer Information Worksheet - City Of Cincinnati Income Tax Division

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Mail worksheet to:
CITY OF CINCINNATI INCOME TAX DIVISION
Cincinnati Income Tax Division
805 Central Avenue Suite 600
TAXPAYER INFORMATION WORKSHEET
Cincinnati OH 45202-5799
Your Name:
SSN:
Spouse's Name:
SSN:
Home Phone: (
)
Work Phone: (
)
Home Phone: (
)
Work Phone: (
)
RESIDENTIAL ADDRESSES (Complete worksheet for the past six years)
RESIDENTIAL ADDRESSES (Complete worksheet for the past six years)
Date From
Date To
Street Address/City/State
Zip Code
Date From
Date To
Street Address/City/State
Zip Code
Present
Present
EMPLOYMENT/INCOME HISTORY (Complete worksheet for past six years)
EMPLOYMENT/INCOME HISTORY (Complete worksheet for past six years)
Date From
Date To
Name of Employer/Income Source
Zip Code
Date From
Date To
Name of Employer/Income Source
Zip Code
Present
Present
SUPPLEMENTAL INFORMATION:
1) Do you and/or your spouse receive Form K-1 income from a partnership or an S-Corporation? (circle option)
YES
NO
2) Do you own rental property? (circle option)
YES
NO
3) If YES, what was the date of purchase?
What do you collect monthly for rent from the property? $
4) Have you or your spouse been self-employed within the past six years? (circle option)
YES
NO
5) If YES, provide specific dates:
From
To
SIGNATURE--I certify that the above information is true and accurate.
SIGNATURE--I certify that the above information is true and accurate.
Your Name
Date
Spouse's Name
Date

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