Taxpayer Information Form
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1NEW RESIDENT QUESTIONNAIRE
1. Name:
2. Address:
3. Telephone Number:
Social Security Number:
__________________
4. Date Springdale Residency Began:
5. Occupation:
_________________________
6. Employer Name:
7. City of Employment:
Date Employment Began:
8. Does Your Employer Withhold a Local Tax on Your Entire
or Partial
Income?
9. Name of City for Which Employer Withholds Local Tax:
______________________
10. Please List All Other Persons Living With You (Use Additional Sheets if Necessary):
Name:
Age:
Annual Income:
Name:
Age:
Annual Income:
Name:
Age:
Annual Income:
Name:
Age:
Annual Income:
11. Name of Any Person Listed Above Who Owns Rental Property:
12. Amount of Rent Received Monthly:
From (Tenants Name):
13. Do You Own
or Rent
Your Home?
14. Landlord’s Name and Address (if applicable):
WRITTEN NOTICE IS REQUIRED TO CHANGE ANY OF THE ABOVE INFORMATION ONCE IT
HAS BEEN SUBMITTED.
Taxpayer Signature:
Date:
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Parent category: Life