Form It-47 - Municipal Income Tax Account Questionnaire
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1IT-47
MUNICIPAL INCOME TAX ACCOUNT QUESTIONNAIRE
!
Please check ( ) the communities in which you are conducting business:
(01) Columbus
2.0%
_____
(10) Obetz
2.0%
_____
(14) Brice
1.0%
_____
(06) Grove City
2.0%
_____
(11) Canal Winchester
2.0%
_____
(15) Lithopolis
1.0%
_____
(09) Groveport
2.0%
_____
(13) Marble Cliff
2.0%
_____
(16) Harrisburg
1.0%
_____
Local Street Address of Business:_________________________________________________________________________________
ACCOUNT TYPE:
(Check all types applicable to you or your business)
S
ole Proprietorship
______
Corporation
_______
Trust or Fiduciary
_______
Partnership
______
Non-Profit
_______
Employer Withholding
_______
Common Carrier
______
Disregarded Single Member Entity_____
must provide information for withholding +100% member
____/____/____
_____/_____/_____
Date you started business within our collection area
Date you first had employees within our collection area
$_______________
__________________________
Approximate monthly payroll amount
If you are using a payroll service, indicate which one
IF SOLE PROPRIETORSHIP
NAME:____________________________________________________________
SSN:___________________________________
HOME ADDRESS:___________________________________________________
CITY:___________________________________
STATE:________________
ZIP:________________
PHONE: (_____)__________________
FAX: (____)_________________
BUSINESS NAME:___________________________________________________
EIN:____________________________________
BUSINESS ADDRESS: ______________________________________________
CITY: __________________________________
STATE:________________
ZIP:________________
PHONE: (_____)__________________
FAX: (____)_________________
CORPORATION/PARTNERSHIP/OTHER
NAME:___________________________________________________________
EIN: _________________________________
DBA:____________________________________________________________
FISCAL MONTH: _______________________
ADDRESS:_______________________________________________________
CITY: ________________________________
STATE:________________
ZIP:________________
PHONE:(_____)___________________
FAX:(____)_________________
MAILING ADDRESS FOR NET PROFIT/LOSS TAX RETURNS: AS ABOVE_____
OR BELOW:
ADDRESS:_________________________________________________________
CITY: ________________________________
STATE:________________
ZIP:________________
PHONE:(_____)___________________
FAX:(____)_________________
CONTACT PERSON:___________________________________________
MAILING ADDRESS FOR EMPLOYER WITHHOLDING TAX RETURNS: AS ABOVE_____
OR BELOW:
ADDRESS:_______________________________________________________
CITY: ________________________________
STATE:________________
ZIP:________________
PHONE:(_____)___________________
FAX:(____)_________________
CONTACT PERSON:___________________________________________
All Cities tax S Corporations at the corporate level. Columbus and Grove City tax earnings of partnerships at the business level.
IF CORPORATION:
______________________________________
________________________________
Name of President or C.E.O (All Corps)
SSN:
___________________________________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP
IF PARTNERSHIP:
Attach separate sheet with the name, SSN or FID and address of each partner.
IF SUB S CORP:
Attach separate sheet with the name, SSN or FID and address of each partner.
_____________________________________________________________
______________________________
Name of Person Completing Form
Phone No./Fax No.
(OVER)
Rev. 09/02
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Parent category: Financial