Business And Professional Questionnaire Form
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1WEST UNION INCOME TAX BUREAU
VILLAGE OF WEST UNION
P.O. BOX 556
PHONE: (937) 217-8855
WEST UNION, OH 45693
FAX: (937) 544-6099
BUSINESS AND PROFESSIONAL QUESTIONNAIRE
Application for: _____ Withholding Account Only
_____ Net Profit Account Only _____ Both Accounts
Name of Business:
Business Owners(s) Name(s):
FID/Social Security Number
Local Mailing Address:
P.O. Box
Home Office Mailing Address
P.O. Box
(if different)
o
o
o
Business Loation(s)
Inside West Union
Outside West Union
Both
Trade Name (DBA) (if different)
Phone Number:
Fax Number:
Contact Person/Title:
Email:
Date Began Operations or Withholdings in/for West Union:
o
o
o
o
Type of Ownership:
CORPORATION
PARTNERSHIP
SOLE PROPRIETORSHIP
SUB. S CORP.
o
o
o
o
LTD LIABILITY
NON-PROFIT
GOVERNMENT AGENCY
OTHER: ________________
Number of Employees Currently : Working in West Union
Residing in West Union
o
o
Method of Filing Withholding Taxes:
Monthly (Mandatory if monthly payroll is $6,500 or more)
Quarterly
o
o
Will a payroll company be filing the company's withholding taxes?
Yes
No
If Yes, what is the name of the company?
o
Accounting Period: Calendar Year:
or Fiscal Year ending:
o
o
Do You Use Subcontractors?
Yes
No If Yes, list the name, address Federal ID/Social Security number on a separate sheet
o
o
If Your Business Is Located Inside West Union Do You Own the Property Where Your Business is Located?
Yes
No
If No, give name and address of landlord
Landlord Owner Name/Address:
*******************************************************************************************************
I certify that the information is accurate and complete to the best of my knowledge. Any false or misleading information is punishable
under the penalties provisions of the West Union Income Tax Ordinance.
Signed:
Title:
Date:
Rev. 7/12
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