Request For Income Tax Clearance 2014
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1
2REQUEST FOR INCOME TAX CLEARANCE
REQUESTING DEPARTMENT/DIVISION: _____________________________________________________________
E-MAIL ADDRESS: _____________________________________________________________
CONTACT NAME: ____________________________________ PHONE: _________________________ FAX: ___________________________
Type of Clearance:
New
Renewal (Please submit 30 days prior to submitting bid or expiration date)
To:
For:
A.
City of Detroit
Individual or
Income Tax Division
Company Name____________________________________________________
Coleman A. Young Municipal Center
Address __________________________________________________________
2 Woodward Avenue, Ste. 1220
Detroit, MI 48226
_________________________________________________________________
Phone: (313) 224-3328 or224-3329
City ______________________________________________________________
Fax: (313) 224-4588
State _____________________________ Zip Code ______________________
Telephone_________________________ Fax # _________________________
E-mail Address ____________________________________________________
B.
Name of Chief Financial Officer/Authorized Contact Person
Telephone #
(include address if different from above)
Fax #
Employer Identification or Social Security Number
Spouse Social Security Number
BID CONTRACT AMOUNT (if known):
Nature of Contract
Labor: $
Material: $
Contract # (if known)
C.
ALL QUESTIONS MUST BE ANSWERED TO EXPEDITE APPROVAL PROCESS. ANY QUESTION NOT
ANSWERED MAY RESULT IN A DENIAL OF INCOME TAX CLEARANCE.
Check One:
Individual
Corporation
Partnership
Estate & Trust
INDIVIDUALS ANSWER QUESTIONS 1,2,3,4.
1.
Have you filed joint returns with spouse during the last seven (7) years? (If yes, incude spouse SSN above)
Yes
No
2.
Are you a student, and/or claimed as a dependent o n someone else’s tax return?
Yes
No
3.
Were you employed in the City of Detroit durnig the last seven (7) years?
Yes
No
4.
Were you a resident of Detroit during the last seven (7) years?
Yes
No
CORPORATIONS AND PARTNERSHIPS ANSWER QUESTIONS 5,6,7.
5
Is the company a new business in Detroit? If yes, attach Employer Registration (Form DSS-4).
Yes
No
6.
Will the company have employees working in Detroit?
Yes
No
7.
Will the company use sub-contractors or independent contractors in Detroit?
Yes
No
D.
FOR INCOME TAX USE ONLY
Has the contractor complied with the provisions of the City Income Tax Ordinance?
Yes
No
Signature
Date
Expires
Yes
No
Signature
Date
Expires
Yes
No
Signature
Date
Expires
VISIT OUR WEBSITE FOR INFORMATION AND TAX FORMS AT:
Please e-mail your completed request
NOTE: An approved Income Tax Certificate may be used in multiple city wide departments that require a bid.
form (preferably in pdf format) to: IncomeTaxClearance@detroitmi.gov
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