Business Income Tax Questionnaire Template - City Of Mason

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CITY OF MASON
BUSINESS INCOME TAX QUESTIONNAIRE
Please assist us in completing your account information. All information is required by Ordinance #50-1970.
Information provided to the Mason Tax Office is kept totally confidential. If you have any question while
completing this form, please contact our office at (513) 229-8535.
Name of Business _______________________________________ Federal ID Number ____-__________
DBA ________________________________________
Social Security Number _____-____-_______
Local Address __________________________________________________________________________
Street
City
State
Zip Code
Telephone ____________________
____________________
___________________
Local
Cell
Fax
Tax/Payroll Contact Person(s) ________________________________________
_________________________
E-mail
Contact Address ________________________________________________________________________
Street
City
State
Zip Code
Contact ____________________
____________________
___________________
Telephone
Cell
E-mail
 Sole Proprietor  Partnership  Corporation  Other (explain) ___________________________
st
End of Fiscal Year:  December 31
 Other _____________________________
Business Product/Service ____________________________________
 Employee Courtesy Withholding Only
Date activity began in Mason ___________ Expected Number of Employees Working in Mason _________
Withholding Payment Method:
 Payroll Service
 Mail
 Ohio Business Gateway
 ACH Credit Electronic Filing Program
Payroll Service Company____________________________________  No Payroll Service Company
Employee Leasing Company _______________________________________________  No Leased Employees
Subcontractors working in the City of Mason  Yes, attach list with names and address  No Subcontractors
Company replaces another company previously registered with the City of Mason?
 Yes, provide name and FEIN of company ________________________________________________  No
Name and Address of Corporate Officers or Partners (or attach list):
______________________________________________________________________________
Name
Title
Address
______________________________________________________________________________
Name
Title
Address
Please Return within 15 days to the Mason Tax Department. Thank you for your cooperation.
6000 Mason-Montgomery Road, Mason, Ohio 45040 513-229-8535 Fax 513-229-8531

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