Business - Income Tax Questionnaire - City Of Springfield Division Of Taxation - 2012
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1City of Springfield
Division of Taxation
P. O. Box 5200
Springfield, Ohio 45502
Phone: (937) 324-7357
Fax: (937) 328-3471
BUSINESS - INCOME TAX QUESTIONNAIRE
The following information is required to properly establish your City of Springfield income tax account.
Please answer all questions fully and return this form to the address above.
(PLEASE TYPE OR PRINT)
=========================================================================================
1. Type of Organization:
Partnership _____ Corporation _____ S Corporation _____ Sole Proprietor _________
(Please check one)
Nonprofit Organization _____ Other (Explain): _______________________
2. Business Name ________________________________________________ Federal ID No. _________________________
3. Type of Business or Trade _____________________________________________________________________________
4. Local Business Address _________________________________________________ Telephone (______)_____________
5. Mailing Address _____________________________________________________________________________________
6. Email Address ______________________________________________________________ FAX (_____)_____________
7. Full Name of Owner(s) __________________________________________ Social Security No. _____________________
8. Home Address _______________________________________________________ Telephone ( ______)______________
9. Date activity started in City of Springfield, _____/______/______
Accounting Period: Calendar Year ______________
or Fiscal Year Ending ______/______/__________
10. Do you own rental properties within the City of Springfield? Yes_______ No ______ If yes, please list property
addresses and date acquired (on back or separate attachment).
11. Do you have employees working in the City of Springfield? No _____ Yes _____ If yes, what date did your employee(s)
start working in Springfield? ____/_____/______
12. Are you withholding only as a courtesy to employees who reside in the City of Springfield ? No_______ Yes _______
If yes, what date did you first start withholding City of Springfield tax? _____/_____/______
13. Are you a Monthly or Quarterly withholder?
M______ Q______ . If your withholding remittance is more than
$1,000.00 per quarter, you must remit withholding tax on a monthly basis.
14. Do you utilize a payroll company? No ____ Yes ____. If yes, payroll company name __________________________
15. Do you use Subcontractors? No ____ Yes _____. If you are using Subcontractors, for any portion of your business, please
indicate the name, address, and Federal ID number(s)/Social Security Number(s) of the company(ies) or individual(s) who
contracted with you for work performed in Springfield. (on back or separate attachment).
16. If you have filed City income tax returns before, show name and address used and which year(s) were filed.
__________________________________________________________________________________________________
17. If this is a change of ownership, give name, address, and telephone number of former owner:
_________________________________________________________________
Date of change _____/_____/______
18. Worksite/job location: _______________________________________________________________________________
Print Name: __________________________ Signature:____________________________ Title:_____________________
Date ____/____/____
(Rev 05.12)
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