Courtesy Withholding Questionnaire Form printable pdf download

CITY OF SPRINGBORO

INCOME TAX DEPARTMENT

320 W. Central Avenue

(937) 748-9701

Springboro, OH 45066-1198

(937) 748-6185 – FAX

COURTESY WITHHOLDING QUESTIONNAIRE

Account #

The following information will aid us in preparing forms for your use in complying with the Springboro income Tax Ordinance.

Please complete the questionnaire and return to City of Springboro, Department of Taxation 320 W. Central Ave. Springboro, OH

45066

Name and address as used for business purposes:

Employer Name____________________________________________________Phone #_____________________

Is above address main office or branch? ______________________If branch, give name and address of main office

Name________________________________________________________________________________________

Address______________________________________________________________________________________

Accounting period used for Federal Income Tax Purposes: Fiscal Year End________________________________

FIN#__________________________________

Do you have employees that live in Springboro? _____YES_______Date started withhold ____________________

Type of Ownership _____Proprietorship _____S-Corp _____C-Corp _____Partnership _____LLC ____Nonprofit

List names, residence address and social security # if partners, corporate officers, association members, agent, etc.

____________________________________________________________________________________________

Mail Withholding Tax Forms To:

__________________________________________________________

Contact Person _____________________________________________

Phone #___________________________________________________

Fax # _____________________________________________________

E-mail Address _____________________________________________

_____________________________________________

______________________________________

Signature of Person Completing Form

Date Completed

Courtesy Withholding Questionnaire Form