Municipal Income Tax Business Registration Form (Page 2 of 2) in pdf

Municipal Income Tax Business Registration Form Page 2

►OTHER:

TYPE: ______________________________________________________________________________________

NAME: _______________________________________________________________SS#____________________

ADDRESS/PHONE: ____________________________________________________________________________

_____________________________________________________________________________________________

►ALL FIRMS:

DOES FIRM HAVE EMPLOYEES ? (circle one)

YES

IF YES, HOW MANY? __________

DOES FIRM USE SUBCONTRACTORS? (circle one)

YES

IF YES, SUBMIT SEPARATE SHEET LISTING EACH SUBCONTRACTOR INCLUDING NAME, ADDRESS, PHONE,

AND FEDERAL ID OR SOCIAL SECURITY NUMBER.

ADDRESS TO WHICH TAX FORMS ARE TO BE MAILED:

BUSINESS NET PROFIT:

NAME: _______________________________________________________________________

CARE OF: ____________________________________________________________________

STREET ADDRESS: ____________________________________________________________

CITY/STATE/ZIP: _______________________________________________________________

PAYROLL WITHHOLDING:

NAME: _______________________________________________________________________

CARE OF: ____________________________________________________________________

STREET ADDRESS: ____________________________________________________________

CITY/STATE/ZIP: _______________________________________________________________

The information hereby submitted, including any accompanying lists and statements, is true and correct to the best of

my knowledge: ____________________________________________________ Date: _______________________

(Signature)

Printed Name: __________________________________________________ Phone: _______________________

Title: _________________________________ Company: ______________________________________________

Address (If different than listed above): ______________________________________________________________

______________________________________________________________________________________________

PLEASE COMPLETE OTHER SIDE

Municipal Income Tax Business Registration Form Page 2