Business Questionnaire Form printable pdf download

CITY OF OREGON - DEPARTMENT OF TAXATION

5330 SEAMAN ROAD

OREGON, OH 43616-2608

419-698-7034

BUSINESS QUESTIONNAIRE

Name: ___________________________________

FEDERAL I.D. #: _____________________

ADDRESS: _______________________________

SOCIAL SECURITY #: _________________

BUSINESS PHONE: ____________________

Section 193.03 of the Codified Ordinances of the City of Oregon imposes a tax at the rate of two and one-quarter (2.25%)

on:

A) All salaries, wages, commissions and other compensation earned within the corporate boundaries of the

City. Each employer within or doing business within the City, who employs one or more persons on a

salary, wage, commission, or other compensation basis, shall at the time of payment thereof, deduct the

tax and remit in accordance with regulations defined in the ordinance, to the Commissioner of Taxation.

B) The portion of net profits attributable to the City of Oregon of a business, profession, enterprise or other

activity.

NATURE OF BUSINESS: _____________________________

2. Starting date of activities in Oregon:

___________________

3. Number of employees to be employed in the City of Oregon: ____________

4. If address shown above is a branch office, show name and address of home office, or vice versa.

____________________________________________________

5. Indicate address to which forms should be mailed: ________________________________________

________________________________________

6. Type of Business Organization:

a. Corporation _____ b. Partnership _____ c. Proprietorship _____ d. Other _____

7. Date of accounting year end: _________

8. If you checked 6c above, show names and address of partners. If you checked 6d above, explain the type of

organization.

____________________________________________________________________

9. If you are withholding Oregon city tax as a courtesy for employees who do not work in Oregon, but do reside in

Oregon, please check here: _____

I certify the above to be true and correct:

_____________________________________________

_______________________________

(Authorized Representative)

(Title)

Business Questionnaire Form