Business Questionnaire - City Of Dublin Division Of Taxation Page 2
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29. Estimated Annual Payroll: _________________ x .02 = _________________ (estimated tax withheld)
Filing will be semi monthly (if income tax withheld is more than $12,000 per year)
Monthly (if income tax withheld is over $1,200 per year but under $12,000 per year)
Quarterly (if income tax withheld is less than $1,200 per year)
10. Please complete the statements below; if applicable:
(A) Number of employees (if sole proprietor do not include yourself)
Full-time: _______ Part-time: _______
(B) Date when employees began working in Dublin
.
(C) _____ We have no employees working in Dublin. We wish to withhold as a courtesy for employees who
live in Dublin starting
.
11. Do you lease business space from others? If so, to whom is rent paid:
Name
Address
City/State/Zip
Telephone No.
Owner:
___________________________________________________________________________________
Agent:
___________________________________________________________________________________
12. Send the net profit tax return to (not applicable for Courtesy Withholders):
Business name:
____________________________________________________________________________
Address:
____________________________________________________________________________
City/State/Zip:
________________________________________ Telephone No. (
) _________________
13. Send withholding report tax form to:
Business name:
____________________________________________________________________________
Address:
____________________________________________________________________________
City/State/Zip:
________________________________________ Telephone No. (
) _________________
14. For Contractors/Sub-Contractors Only:
(A) Are you a general contractor or sub-contractor? _______________________________________________
(B) Location of current job: _____________________________________________________________________
(C) Probable length of job: from: _________ to: _________
Estimated cost of job: ____________________
(D) Will you be doing more than one job in Dublin?
(E) Name and address of party from whom work is contracted:
Name:
____________________________________________________________________________
Address:
____________________________________________________________________________
(F) Will you be sub-contracting any of the work to someone else? If yes, please attach a list with name and
addresses.
15. Does your organization use a payroll service?
If yes, provide name:
.
THE INFORMATION HEREBY SUBMITTED IS TRUE AND CORRECT:
Signature: __________________________________ Date: ___________________
Title:
__________________________________
Company: __________________________________
To avoid delays in processing, please check the information given to verify accuracy and detail. Your
cooperation is appreciated.
REMIT TO:
CITY OF DUBLIN
P.O. Box 9062, Dublin OH 43017-0962 (614) 410-4460 FAX (614) 923-5543
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