Form It-1 - Combined Application For Registration As An Ohio Withholding/school District Withholding Agent

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Form IT-1
(Rev. 2/01)
Central Registration Unit
P.O. Box 182215
Columbus, OH 43218-2215
Combined Application for Registration as an Ohio
Withholding/School District Withholding Agent
Please Type or Prin t
-
Reactivate for Account No. _________________________
c
c
Please Select
Ohio Withholding
School District Withholding
-
Federal Employer Identification No. ____________________________
Charter No. _____________________________
Business Type Code No. (see below) ______________________
Legal Name _______________________________________________________________________________________
Trade Name/DBA ___________________________________________________________________________________
North American Industrial Code System or Standard Industry Code (if unknown, leave blank) ______________________
Date Ohio Payroll Anticipated __________________
County: _____________________________________________
Primary Address (Home Office/Residence) _______________________________________________________________
__________________________________________________________________________________________________
Mailing Address ____________________________________________________________________________________
__________________________________________________________________________________________________
Home Telephone No. ____________________________
Business Telephone No.____________________________
Ohio Liquor Permit No. ________________________
c
Required to Withhold School District Income Tax (check here)
If you need to activate your School District Account at a
later date, please call 1-888-405-4089.
Name, Social Security No. and Title of Individual Responsible for Filing Returns and Payment of Ohio Withholding/
School District Withholding Tax.
Name ________________________________________________
SSN ____________________________________
Title ______________________________________________________________________________________________
Signature of Above ___________________________________________________
Date ______________________
005
Individual
150
Non Profit
010
Sole Proprietor
160
National Bank
020
General Partnership
170
State Bank
030
Corporation
180
S Corporation
040
Professional Association
190
Agricultural Association (Co-op)
050
Limited Liability Company
230
Dealer in Intangibles
060
Fiduciary
240
Insurance
070
Limited Liability Partnership
250
Federal Credit Union
080
Limited Partnership
260
State Credit Union
090
Trust
270
State Savings & Loan
100
Business Trust
275
Federal Savings & Loan
110
Regulated Investment Company
280
Federal Government
120
Real Estate Investment Trusts
290
Local Government
130
Real Estate Mortgage Investment Conduits
300
State Government
140
Public Utility
999
Other

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