Individual Questionnaire - City Of Springboro, Ohio printable pdf download

CITY OF SPRINGBORO

INCOME TAX DEPARTMENT

320 W. Central Avenue

(937) 748-9701

Springboro, OH 45066-1198

(937) 748-6185 – fax

INDIVIDUAL QUESTIONNAIRE

ACCOUNT #

In accordance with the City of Springboro Ordinance #731 which became effective July 1, 1978, all residents are required to pay a City Income

Tax at the rate of one and one half percent (1.5%) per annum on all salaries, wages, commissions, and some other types of compensation. In

order to determine your city tax liability, if any, the following information is required. Please answer all questions carefully and return this

questionnaire within ten (10) days

Name __________________________________Soc Sec.#__________________________ Phone #________________________

Address___________________________________________________ Date moved to Springboro_________________________

Previous address___________________________________________________________________________________________

Name of Employer_______________________________________Work phone #______________________________

Address where work is performed ____________________________________________________________________________

Business type ______________________________________________Contact Person__________________________________

Is employer withholding city tax _______________For what city ___________________________________________________

Spouse’s Name____________________________________________Soc. Sec.#_______________________________________

Name of Employer________________________________________________Work phone#______________________________

Address where work is performed ____________________________________________________________________________

Business type ______________________________________________Contact Person__________________________________

Is employer withholding city tax ________________For what city __________________________________________________

List names and employers of other persons living in your household and working.

NAME

EMPLOYER & LOCATION OF WORK

_________________________________________

_____________________________________________

_________________________________________

_____________________________________________

Do you own home_____ Rent _____ If renting, give name & address of landlord______________________________________

________________________________________________________________________________________________________

If you have income from sources other than salaries, wages, or commissions, please complete the information below, Income from

poor relief, unemployment compensation, social security, pensions, military pay and similar payments are exempt from city tax.

Do you own rental property? Yes _____ No _____ List addresses of landlord________________________________________

________________________________________________________________________________________________________

Income from rental properties is taxable when the monthly gross rental is in excess of $250.00 per month. It is requested of all

owners of rental properties in Springboro to submit the names and addresses of all tenants.

Do you have any other income? Yes _____ No _____ If yes, what type______________________________________________

The statements made on this questionnaire are true, correct and complete.

Signature__________________________________________________Date___________________________________________

Spouse’s Signature __________________________________________Date __________________________________________

Email address ____________________________________________________________________________________________

Individual Questionnaire - City Of Springboro, Ohio