New Business Questionnaire - Income Tax Department Form

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Village of Evendale
INCOME TAX DEPARTMENT
Phone (513)563-2671
10500 Reading Road
Fax
(513)563-4636
Evendale, Ohio 45241
NEW BUSINESS QUESTIONNAIRE
Note: Questionnaire is to be completed by any resident business located in the Village of Evendale
or any nonresident business providing services or operating within the village.
Corporate/Business Name
DBA, if applicable
Federal ID Number
Corporate Phone Number
Corporate Address
Corporate Fax Number
Evendale Address
Evendale Phone Number
(or work site location)
Evendale Fax Number
**PLEASE NOTE: BUSINESS NAME AND CONTACT INFORAMTION ONLY MAY BE SHARED WITH OTHER
DEPARTMENTS WITHIN THE VILLAGE OF EVENDALE (i.e. FIRE, POLICE, SERVICE DEPTS)**
Type of Business
Sole Proprietorship
Partnership
S-Corporation
Corporation
Ltd. Liability Co.
Non-Profit
Accounting
Calendar Year
Fiscal Year
Names of Corporate Officers or Partners:
Name
Address
Social Security Number
Title
Name of Operations
Date operations are expected to begin in Evendale
Number of Employees expected at Evendale location
Date of first payroll
Is this a courtesy withholding tax for an Evendale resident?
Yes
No
Indicate address to which payroll forms should be mailed:
Evendale
Corporate
N/A- OBG Filer
N/A-Payroll Service
If a resident business, is Evendale location Rented (leased)?
Yes
No
If yes, please provide Name and Address of Landlord:
I hereby certify that to the best of my knowledge the above information is true, correct and complete.
Name
Title
Date
(please print)
Signature
Telephone Number
Email address to which you would like the account number(s) sent
Approved By
Date
Business Account
Withholding Account

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