Business Questionnaire Form - Ohio Income Tax Division
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1B A R C O D E
L A B E L
BUSINESS QUESTIONNAIRE
INCOME TAX DIVISION
1 Cascade Plaza - 11th Floor
Akron, OH 44308 -1100
(330) 375-2290
Fax (330) 375-2112
The following information is necessary for us to update your income tax records with the City of Akron.
If additional space is
needed, use the back of this form.
PLEASE COMPLETE AND RETURN THIS QUESTIONNAIRE WITHIN TEN (10) DAYS.
TAX OFFICE USE ONLY
Date issued ______________________________
Agent/Auditor _____________________________
Account No. ______________________________
Akron Dist ____________ Ind Code__________
BUSINESS NAME _____________________________________________________________________________________________________________
BUSINESS ADDRESS _________________________________________________________________________________________________________
(MAILING ADDRESS FOR TAX PURPOSES)
BEGINNING DATE OF AKRON ACTIVITY _______________________________________________ TELEPHONE # _________________________
AKRON ADDRESS ___________________________________________________________________________________________________________
AKRON TELEPHONE # _____________________________
IS AKRON:
THE HOME OFFICE? ________
A BRANCH OFFICE? ________
If there is no Akron address, are any net profits attributable to Akron?
YES ______
NO
TRADE NAME (if any) _________________________________________________________________________________________________________
FED ID #______________________________________ NATURE OF BUSINESS _______________________________________________________
TYPE OF ORGANIZATION : ! Sole Proprietorship
! S Corp
! C Corp
!
! LLC
Partnership
___________________________________________________________________________________________________
OWNERS
NAME
ADDRESS
SOC
SEC
NUMBER
___________________________________________________________________________________________________
OWNERS
NAME
ADDRESS
SOC
SEC
NUMBER
NUMBER OF EMPLOYEES WORKING IN AKRON ___________
DATE FIRST EMPLOYEE WAS HIRED _______________________________
ACCOUNTING PERIOD USED:
CALENDAR YEAR _______
FISCAL YEAR _______
(Fiscal Year Ending __________ )
Do you own rental property in Akron?
YES_____
NO _____
(If yes, we will send you a rental questionnaire upon receipt of this form.)
Do you operate more than one place of business in Akron?
YES _____
NO______
Address ____________________________________________________
Trade Name ________________________________________________
Address ____________________________________________________
Trade Name ________________________________________________
IF CURRENT BUSINESS IS THE SUCCESSOR TO A PRE-EXISTING BUSINESS, PLEASE COMPLETE THE FOLLOWING:
Name/s of previous owner/s and trade name, if any _______________________________________________________________________________
____________________________________________________________________________________________________________________________
Mailing Address ______________________________________________________________________________________________________________
Former Business Type :
Sole Proprietorship _____
S Corp ____
C Corp____
Partnership ___
LLC___
Under penalties of perjury, I certify that all information and statements herein are true and correct.
Print Name & Title ____________________________________________________________________________________________________________
Signature ____________________________________________________________________________ DATE _________________________________
7/2002
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