Landlord Questionnaire Form - City Of Canfield Income Tax Department
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1
2LANDLORD QUESTIONNAIRE
CITY OF CANFIELD INCOME TAX DEPARTMENT, 104 LISBON STREET, CANFIELD, OHIO 44406-1416
Phone: 330-533-1101 ~ Fax: 330-533-2668 ~ Web-site:
~ E-mail:
vshook@ci.canfield.oh.us
Name:
DATE:
Address:
Per Ordinance 183.03 the imposition of one percent tax on all salaries, gross wages, commissions, tips, gratuities, and other
compensation earned by resident or non-resident. To establish and maintain accurate records, the Income Tax Ordinance requires that
you complete and return this form within ten days.
FAILURE TO COMPLY WITH THE REQUIREMENTS OF PROVIDING THIS INFORMATION TO THE CITY AS REQUIRED
CODIFIED ORDINANCE 183.03 IS A VIOLATION OF THE LAW PUNISHABLE BY A FINE OF UP TO $1,000.00 PER ORDINANCE
183.99.
PLEASE PRINT.
1. Owner’s name __________________________________________
2. Soc. Sec. # _________________________
3. Address _______________________________________________________ 4. Phone ______________________
5. Spouse’s name _________________________________________
6. Soc. Sec. # _________________________
7. Address _______________________________________________________ 8. Phone______________________
9. Business name _________________________________________ 10. FEIN ______________________________
11. Address ______________________________________________________________________________________
12. If filed a prior City of Canfield Income Tax Return, give name and account # used.
Name used ____________________________________________________________ Account # ______________
13. Address of rental property within the City of Canfield (attach list if necessary).
14. No Units
15. Date of purchase
_____________________________________________________________
________
________________
_____________________________________________________________
________
________________
16. Check accounting period used for Federal Tax: __ Calendar Year ending Dec. 31 __ Fiscal Year ending __________
17. Number employees in the City of Canfield? _____ 18. Is withholding for Canfield $100.00 or more per month? _____
19. Attach a list of employees (including building managers, custodial, maintenance, etc for whom no tax is withheld.
Include name, address, and SSN of each person.
20. If a payroll service is used please give name of service, contact person, & phone number. ______________________
______________________________________________________________________________________________
21. Type of ownership: __ Individual Proprietorship __ Corporation __ S Corp __Partnership __ LLC __ Non-Profit
22. Send Business Net Profit Form To:
23. Send Withholding Forms To:
Name ________________________________________ Name _________________________________________
Care of _______________________________________ Care of _______________________________________
Address ______________________________________
Address ______________________________________
City ________________ State ____ ZIP _____________ City _______________ State ____ ZIP_____________
Phone ____________________
Phone ________________________
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