Business Registration Form - Village Of New Concord Income Tax Department Page 2

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VILLAGE OF NEW CONCORD INCOME TAX DEPARTMENT
PO BOX 10
2 WEST MAIN STREET
NEW CONCORD OH 43762
Phone 740/826-7671
Fax 740/826-7617
BUSINESS QUESTIONNAIRE
TO INSURE ACCURATE RECORDS, PLEASE ANSWER ALL QUESTIONS THAT PERTAIN
TO YOUR TAXABLE STATUS IN THE VILLAGE OF NEW CONCORD. PLEASE COMPLETE
AND RETURN WITHIN 10 DAYS. YOUR COOPERATION IS APPRECIATED.
GENERNAL INFORMATION
BUSINESS NAME ___________________________________________FED ID#__________________
TRADE NAME (if different) ____________________________________________________________
NATURE OF BUSINESS _______________________________________________________________
MAIN BRANCH ADDRESS _____________________________________________________________
CITY, STATE, ZIP _____________________________________________________________________
PHONE NUMBER (Main Branch) _____________________ (Local Address) ____________________
LOCAL ADDRESS (if different) _________________________________________________________
TYPE OF OWNERSHIP:
_______ Sole Proprietorship
Name of Owner_________________________________________________________________
Address________________________________________________________________________
Telephone #_____________________________________________________________________
Social Security #______________________________ Federal EIN________________________
_______ Partnership
Name of Partnership_____________________________________________________________
Federal EIN____________________________________________________________________
How will the net profit Village Income Tax return be filed and paid?
_____In full by the business ______Separately by the individual partners on proportionate shares
Partners’ Information:
Name_____________________________________ Social Security #______________________
Address________________________________________________________________________
Name_____________________________________ Social Security #_______________________
Address________________________________________________________________________
Name_____________________________________ Social Security #_______________________
Address________________________________________________________________________
Name_____________________________________ Social Security #_______________________

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