Form Business Entity Questionnaire - York Adams Tax Bureau (Page 3 of 3) in pdf

Form Business Entity Questionnaire - York Adams Tax Bureau Page 3

BUSINESS ENTITY QUESTIONNAIRE (cont.)

Name of the firm who will prepare your quarterly and annual tax returns, if an outside source is utilized.

Name __________________________________________________________________________________________

Address ________________________________________________________________________________________

Contact __________________________ Phone ________________________ Fax _________________________

10.

Was this business acquired from a predecessor? Yes __________

No __________

If yes, predecessor's name _________________________________________________________________________

Account number utilized for reporting to this bureau _______________________

Date when you acquired your predecessor's business _______________________

11.

Current Number Of W2 Employees to be reported with Y. A. T. B. ___________________________

12.

To be answered by corporate employers: Provide the full name and address of the officer(s)

having primary responsibility, or overseeing the discharge of registering with the York Adams Tax Bureau;

deducting or withholding local income tax from employees' compensation as defined in the act; paying withheld tax to

the bureau; filing returns, reconciliations or withholding statements as required by ordinance, resolution or statute.

Name ___________________________________________________________________________________________

Address _________________________________________________________________________________________

I hereby certify that all information and statements are true and correct.

Date ___________________________

Authorized Officer's name (printed) ____________________________________________________________________

Authorized Officer's Signature _________________________________________________________________________

Your business E-Mail address (optional) __________________________________________________________________

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Form Business Entity Questionnaire - York Adams Tax Bureau Page 3