City Of Dublin Business Registration Form
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1Date: _______________
City of Dublin Business Registration
(Not for Sole Proprietors)
“It’s Greener in Dublin”
The information requested on this form is essential to the establishment of your account and will be held in strict confidence.
Please complete and return it to the City of Dublin Taxation, P.O. Box 9062, Dublin, Ohio 43017-0962 within 10 days. If you have
any questions, please contact City of Dublin Taxation @ 614-410-4434 Fax: 614-923-5554.
Type of Organization (Please check one)
Corporation
Partnership
Non-Profit
Limited Liability Co (LLC)
Other (Please Explain)
If limited Liability Company (LLC) will partners or individuals file? ____________________________________________
I am filing a Consolidated Return
Yes
No
Federal ID #
Federal ID #
____________________________
____________________________
(Net Profit)
(Withholding)
Business Name ____________________________________________
dba ____________________________________
Street Address: ________________________________
City ____________________
State _____
Zip __________
Phone Number # _________________ Fax # _________________ Type of Business ___________________________
NAICS Code ___________________________ (1120S Box B, 1120 Schedule K line 2A and 1065 Box C)
List Social Security Number and name of Corporate Officers and/or Partners (addresses’ if partnership)
Name _____________________________________________________________ SSN ____________________________
Street Address: _________________________________
City ____________________
State _____
Zip __________
Name _____________________________________________________________ SSN ____________________________
Street Address: _________________________________
City ____________________
State _____
Zip __________
If additional space is needed please send an attachment.
Do you have a location within the City limits of Dublin
Yes
No
If yes, please give the address of Dublin location, if not sure call 614-410-4460 to verify
Street Address: _________________________________
City ____________________
State _____
Zip __________
Date operations will begin in Dublin _____________
Number of employees at Dublin location _____________
Do you wish for your forms to be sent to another location
Yes
No
If Yes please give the address
Street Address: _________________________________
City ____________________
State _____
Zip __________
Please check an appropriate box
Employees work within city limits of Dublin – Withholding rate is 2.00%
Your business performs no work in Dublin and Dublin taxes are deducted from residents as a courtesy.
No Employees
Are you currently using a payroll processing company
Yes
No
If yes, your Dublin Income Tax Account Number is your FIN number.
If yes, please indicate company name, contact person and phone number ___________________________________
Please indicate deposit frequency. If a withholding service is being used advise them to withhold accordingly.
Quarterly (under 100.00/month)
Monthly (over 100.00/month)
Semi Monthly (over $1,000/month)
If you are other than a calendar year filer, indicate the month your fiscal year ends _______________________
Person to contact regarding this account _________________________________ Phone # _______________________
Please note: Dublin is not a pure zip code for taxing purposes, if you have any questions regarding what tax district
you are in, please call and we will be happy to verify this information for you. Forms are available on our Web site
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