Withholding And Business Registration - City Of Lorain Income Tax Division Page 2

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For PARTNERSHIP Entities: On the lines below list the Full Name/Address/ SSN # and Phone # of Each Partner
For CORPORATION: On the lines below list the Full Name, Address, Social Security # and Phone # of Each Officer
For S CORPORATION: On the lines below list the Names and Addresses of all Shareholders
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Signature: _________________________________________________________
Date: ________________________

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