Withholding And Business Registration - City Of Lorain Income Tax Division
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1
2WITHHOLDING AND BUSINESS REGISTRATION
City Of Lorain Income Tax Division
th
605 West 4
Street, Lorain OH 44052
Phone: 440-204-1002 / Fax: 440-204-1006
Email:
Web:
2.00%
TAX RATE
ALL INFORMATION IS REQUIRED; ALL INFORMATION IS CONFIDENTIAL
Company Name:
Phone #:
DBA:
Fax #
Email Address:
Local business or Job Site Address:
Business Start Date in Lorain:
If Temporary, Anticipated Ending Date:
Nature of Business:
Number of Employees:
Federal ID # (EIN):
NAICS # (if known):
CHECK BUSINESS TYPE
Sole Proprietor:
Partnership:
S-Corporation:
Corporation:
Limited Liability Co:
Non-Profit Corp:
Estate or Trust:
Other:
SOLE PROPRIETOR Name:
Address:
Social Security
Phone #:
Email:
For PARTNERSHIP Entities: List on the Back of this Form the Full Names, Addresses, Social Security # and Phone # of Each Partner
For CORPORATION: List on the back of this form the Full Name, Address, Social Security # and Phone # of Each Officer
For S CORPORATION: List on the back of this form the Names and Addresses of all Shareholders
Indicate Accounting Period: Calendar Year (Y/N):
OR
Fiscal Year Ending (mm//dd):
Company’s Accountant Name/Address/Phone #:
PAYROLL INFORMATION
Will You Be Withholding Employment Taxes, Yes or No:
Will The Withholding Be More Than $2,000.00 Per Month, Yes or No:
Will You Only Be Withholding As A Courtesy For A Lorain Resident, Yes or No:
-
If Courtesy Withholding, Please Give Name And SSN:
-
Date Withholding Will Begin:
Do You Presently Use An Outside Payroll Service, Yes or No:
-
If Yes, Please Give Name of Payroll Service:
Do You Lease Employees From An Employment Agency, Yes or No:
st
NOTE: All taxable income not reported on a W-2 Form must be submitted on a 1099 Misc. Form by Jan. 31
of each filing year.
Full Name, Address and Phone # of the Person(s) or Entity to Whom Your Lorain Location Pays Rents:
IF BUSINESS WAS AN OUTGROWTH OF ANOTHER; PLEASE COMPLETE THE FOLLOWING
Name of Former Owner(s):
Trade Name (if any):
ID #:
Mailing Address:
Type of Organization: Individual
Partnership
Corporation
S Corporation
Association
Nature of Change:
Sale
Discontinuance
Change in Organization
Other:
Signature: _________________________________________________________
Date: ________________________
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Parent category: Financial