Warren City Income Tax Departmeformnt Individual Questionnaire Form (Page 2 of 2) in pdf

7. List below each employer (starting with your present or last employer) during the

past five (5) years.

EMPLOYER

DATE FROM – DATE TO

___________________________________________________________

If Spouse has been employed at any time during the past five (5) years, list below.

___________________________________________________________

8. Have you been the proprietor of a business in Warren during the past

five (5) years?

□ YES

□ NO

If yes, list name and location of business.

___________________________________________________________

9. Do you own or are you buying the home you live in? □ YES

□ NO

10. Do you own rental property in the city of Warren?

□ YES

□ NO

If yes, list locations of all rental property and the amount received monthly.

_________________________________________________________

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT

Signature ____________________________________________________________ Date __________________

Spouse ______________________________________________________________ Date __________________

This Questionnaire must be submitted to the Income Tax Department whether or not

there is any liability for Warren City Income Tax. All persons who are subject to the

tax imposed by Warren Ordinance must file an annual return whether or not a tax is

due. The tax rate is 2%.

For questions concerning this form call (330) 841-2551 or fax (330) 841-2626.

Warren City Income Tax Department

418 Main St SW

PO Box 230

Warren, OH 44482

Warren City Income Tax Departmeformnt Individual Questionnaire Form Page 2