Confidential Business Registration - City Of Blue Ash - Ohio Income Tax Division
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1City of Blue Ash
Income Tax Division
4343 Cooper Road - Blue Ash, Ohio 45242-5699
Phone: (513) 745-8516; Fax: (513) 745-8651
or Email Address:
CITY OF BLUE ASH CONFIDENTIAL BUSINESS REGISTRATION
NAME OF BUSINESS:
__________________________________
FEDERAL ID/TIN NUMBER: ________________________________
CORPORATE ADDRESS:
__________________________________
CORPORATE PHONE NUMBER: ____________________________
__________________________________
CORPORATE CONTACT PERSON: __________________________
BLUE ASH ADDRESS:
____________________ SUITE: _______
BLUE ASH PHONE NUMBER:
__________________________
__________________________________
BLUE ASH CONTACT PERSON: ____________________________
CONTACT EMAIL ADDRESS:_______________________________
NATURE OF BUSINESS: ____________________________________
FAX NUMBER:___________________________________________
ACCOUNTING PERIOD:
___ CALENDAR YEAR or
(mark one)
___ FISCAL YEAR ENDING _________
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# _________________
NUMBER OF LEASED EMPLOYEES AT BLUE ASH LOCATION: _____
LEASED EMPLOYEES?
SERVICE NAME
ADDRESS
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 _________________
Please return completed form to: Blue Ash Tax Office, 4343 Cooper Road, Blue Ash, OH 45242-5699 or fax to (513) 745-8651
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