Business Questionnaire - City Of Blue Ash

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City of Blue Ash
Income Tax Division
4343 Cooper Road - Blue Ash, Ohio 45242-5699
Phone: (513) 745-8516; Fax: (513) 745-8651
CITY OF BLUE ASH BUSINESS QUESTIONNAIRE
NAME OF BUSINESS:
__________________________________
FEDERAL ID NUMBER:
_______________________________
CORPORATE ADDRESS:
__________________________________
CORPORATE PHONE NUMBER: _________________________
__________________________________
CORPORATE CONTACT PERSON: _______________________
BLUE ASH ADDRESS:
____________________
SUITE: _______
BLUE ASH PHONE NUMBER:
__________________________
__________________________________
BLUE ASH CONTACT PERSON: __________________________
• CALENDAR YEAR or
NATURE OF BUSINESS: ___________________________________
ACCOUNTING PERIOD:
• FISCAL YEAR ENDING _________
(mark one)
TYPE OF BUSINESS (please mark one):
•
•
•
•
•
•
Sole Proprietorship
Partnership
S Corporation
Corporation
Ltd. Liability Co.
Non-Profit
NAMES OF CORPORATE OFFICERS (IF APPLICABLE):
NUMBER OF EMPLOYEES AT BLUE ASH LOCATION: _____________
PRESIDENT: ____________________
SS# _________________
APPROXIMATE MONTHLY PAYROLL: _________________________
TREASURER: ___________________
SS# _________________
PARTNERS (IF APPLICABLE):
Name
Address
SS#
STARTING DATE OF BLUE ASH ACTIVITY: _______________
1. ________________
___________________
_______________
ARE THE PREMISES IN BLUE ASH RENTED/LEASED? ______
2. ________________
___________________
_______________
IF YES, FROM WHOM?:_________________________________
3. ________________
___________________
_______________
_____________________________________________________
NON-RESIDENT BUSINESS (CONTRACTORS, VENDORS, ETC.) TEMPORARILY CONDUCTING BUSINESS IN BLUE ASH:
ADDRESS OF BLUE ASH JOBSITE:__________________________________________________________________________________________
ATTACH COMPLETE LISTING WITH ADDRESSES AND PHONE NUMBERS OF ALL SUBCONTRACTORS
I CERTIFY THE ABOVE INFORMATION TO BE TRUE, COMPLETE, AND ACCURATE.
SIGNATURE: _____________________________ TITLE _____________________
DATE _________________

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