Income Tax Form For New Residents - Village Of Thurston Page 2

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Village of Thurston
Income Tax Household Information Form
Please provide the following information for any household member 18 years of age or
older.
_________________________________
_____________________
Name
Social Security Number
_________________________________ Thurston, OH 43157
Address
Phone #_______________________ Cell #______________________
_________________________________
_____________________
Spouse’s Name
Social Security Number
_________________________________
_____________________
Other Resident’s Name & Relationship
Social Security Number
_________________________________
_____________________
Other Resident’s Name & Relationship
Social Security Number
_________________________________
_____________________
Other Resident’s Name & Relationship
Social Security Number
Please return this form immediately to:
Village of Thurston
PO Box 188
2215 Main St.
Thurston OH 43157

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