Business Questionnaire - City Of Youngstown - Ohio Income Tax Division Page 3

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BUSINESS QUESTIONNAIRE . . . CITY OF YOUNGSTOWN, OHIO
DEPARTMENT OF FINANCE
INCOME TAX DIVISION
How was business acquired?
Purchased
Started New
Incorporated
Reorganized
If local business is a branch, give name and address of Parent Company:
Name
Address
ZIP
Address to which tax returns are to be mailed:
Name
Care of
Address
Address to which employer tax forms are to be mailed:
(If same – write “SAME”)
Name
Care of
Address
IF PARTNERSHIP, ASSOCIATION, JOINT VENTURE OR SMALL BUSINESS CORPORATION, LIST NAME AND ADDRESSES OF
PARTNERS, ASSOCIATES OR MEMBERS
NAME
ADDRESS
CITY
STATE
DO YOU OPERATE ANY OTHER BUSINESS WITHIN OR OUTSIDE OF YOUNGSTOWN WHICH IS SUBJECTED TO CITY OF
YOUNGSTOWN INCOME TAX
NATURE OF
Y-TOWN TAX
BUSINESS NAME
ADDRESS
BUSINESS
ACCOUNT NUMBER
The information hereby submitted, including any accompanying lists and statements, is true and correct
Signature
Dated
Phone Number
Questionnaire prepared by
ATTACH ANY ADDITIONAL INFORMATION AS NECESSARY
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