Business Questionnaire Form
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1City of Troy Income Tax Division
BUSINESS QUESTIONNAIRE
100 S Market St, Troy OH 45373
Phone (937) 339-3861 Fax (937) 440-1352
TROY’S TAX RATE IS 1.75%
The following information will assist us in determining your liability to the City of Troy and to determine your filing requirements. Please
answer questions fully and return this questionnaire to the address shown above. The information provided will assist us in establishing the
proper tax accounts for your business.
If you have any questions concerning this questionnaire, or about the municipal income tax, please
do not hesitate to contact us.
GENERAL INFORMATION
Business Name:__________________________________
Trade Name (if different):________________________
Nature of Business:_______________________________________________________________________________
Home Office Address:____________________________________________________________________________
Phone:_______________________________________
Troy Location (if different):________________________________ Phone:________________________________
Federal Identification Number:________________________ or Owner’s Soc Sec Number:_____________________
Type of Organization:
Sole Proprietor
Corporation
Partnership
Other:_________________
Date business began in Troy:_____________________
EMPLOYEE WITHHOLDING INFORMATION
Date employees began working in Troy:_________________ Number of employees working in Troy:_____________
Are you a non-resident employer withholding for resident employees only?_____________ (Courtesy Withholding)
Date Courtesy Withholding began:__________ Number of employees subject to Courtesy Withholding:_______
Location where work is actually performed:_________________________________________________________
ACCOUNTING INFORMATION
Accounting Period:
_____ Calendar Year
or
______ Fiscal Year (Month ending:_________________)
Name, address and phone number of bookkeeper / accountant:____________________________________________
________________________________________________________________________________________
Name and address of all owners, partners or principal corporate officers:
NAME
ADDRESS
SSN
PHONE #
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
CONTRACTOR AND SUBCONTRACTOR INFORMATION
Name and address of party from whom contracted:______________________________________________________
_________________________________________________________________________________________
Location of job:________________________________ Probable length of job: From____________ to __________
Are you or will you be subcontracting any portion of the work to someone else? _______________ (Yes or No)
If “yes”, attach list of names, addresses, type of work, and amount paid.
______________________________________________ ___________________________
_________________
Completed By
Title
Date
___________________________
_________________
Phone Number
E-Mail
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