Village Of Holland Division Of Taxation Business Questionnaire Form printable pdf download

VILLAGE OF HOLLAND

DIVISION OF TAXATION

BUSINESS QUESTIONNAIRE

The following information is essential to the completion of our records and will be held in strict confidence as

authorized by Ordinance 11-1964. Answer all questions fully and return form promptly to: Village of Holland, Tax

Administrator, 1245 Clarion Ave, Holland OH 43528. FAILURE TO COMPLETE THIS FORM AND

RETURN IT WITHIN 30 DAYS TO THE TAX ADMINISTRATOR OF THE VILLAGE OF HOLLAND IS

A VIOLATION OF HOLLAND CODIFIED ORDINANCES CHAPTER 109.

1. Name of Owner(s)____________________________________________ Phone ________________________

2. Name of Officers (if corporation)______________________________________________________________

3. Trade Name (if any)________________________________________________________________________

4. Business Address_____________________________________________ Phone________________________

5. Holland Address___________________________________________________________________________

6. Mailing Address (if different)_________________________________________________________________

7. Starting Date of Holland Activities_____________________________________________________________

8. Type of Organization: Corporation_____ S Corporation_____ Individual Proprietor_____ Partnership_______

If Partnership or S Corporation, attach statement listing name(s) and address(es) of partners/shareholders.

9. Are there now or will there be employees subject to Income Tax? Yes_____ No____

10. If you are withholding Holland income tax as a courtesy for employees who do not work in but reside in

Holland, please check here_______.

11. If leasing employees to a Holland business, provide name of business______________________________

12. Do you use a payroll service, if so please provide name of service__________________________________

13. Accounting Period Calendar Year_________ Fiscal Year Ending________________

14. Federal Tax I. D. Number ________________________

15 Nature of Business_________________________________________________________________________

16. Is local address the home office or branch_______________________________________________________

17. If no Holland address, are there profits attributable to Holland yes_____ no_____

18. If you operate more than one place of business, give trade name and location of each:

___________________________________________________________________________________________

IF BUSINESS WAS OUTGROWTH OF ANOTHER, FILL IN THE FOLLOWING:

19. Name of previous owner(s)

__________________________________________________________________________________________

20. Trade Name______________________________ Mailing Address_________________________________

21. Type of Oganization_______________________________________________________________________

22. Nature of Change: Sale______ Discontinued_____ Other _________________________________________

I do hereby certify the above information to be true and correct

_________________________________________________

__________________________

Signature

Date

Rev. 12/2006

Village Of Holland Division Of Taxation Business Questionnaire Form