Employer'S Withholding Account Questionnaire Form - Ohio Income Tax Bureau

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City of Reading, Ohio
Melvin T. Gertz
TREASURER
INCOME TAX BUREAU
1000 MARKET STREET
(513) 733-0300
READING, OHIO 45215-3283
FAX (513) 842-1016
Account # 3 - _______________ (City will assign)
EMPLOYER’S WITHHOLDING ACCOUNT QUESTIONNAIRE
(Please Complete & Return Within Ten (10) Days)
1. Name of Business: ______________________________________________________________
2. Social Security # or Fed ID # ______________________________________________________
3. Business Address: ______________________________________________________________
Telephone #: _____________________ Fax # ____________________
4. Please Check Appropriate Description:
A. Please give location address in Reading: _____________________________________
B. Number of days on job site in Reading:
_____________________________________
C. Nature of business: _______________________________________________________
D. Number of employees at Reading address: ___________________________________
E. Date to Begin Withholding: ________________________________________________
F. Withholding for Employee(s) who is resident of Reading: ___ 2.0% ___ .5% ___ Other
TYPE OF ORGANIZATION:
Individual Proprietor
Partnership
Corporation
Non-Profit
Association
Limited Liability Corp.
If a Partnership, Association, or other Unincorporated Joint Business Venture, indicate how the
Reading Income Tax Return, based upon the net profit, will be filed and paid:
In Full By the Business
Separately by Individual Members
If a Partnership, give Name, Title, and Address of all Partners:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
5.
Contact Person: _________________________ Title: _________________________
6.
Business Accounting Period
Calendar Year
Fiscal Year Ending ____________
7.
Opening Date of Business (in Reading) ____________________________________________
8.
Do you have Net Profits attributable to Reading?
Yes
No
9
Do you operate more than one Business in Reading?
Yes
No
If Yes, give Name: _________________________ Fed ID# _________________________
Address: _________________________________________________________________
______________________________
_______________________
____________
Signature
Title
Date

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