City Of Brook Park Business & Corporation Registration Form
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1City of Brook Park, Tax Department
6161 Engle Rd., Brook Park, OH 44142
Phone (216) 433-1533
Fax (216) 433-0822
CITY OF BROOK PARK BUSINESS & CORPORATION REGISTRATION FORM
DATE MOVED/STARTED IN CITY
FED. I.D. NO.
LOCAL BUS. NAME
SOC. SEC. NO.
LOCAL BUS. ADDRESS
CORP. PHONE NO.
CITY
STATE
ZIP
ACCOUNT PERIOD USED FOR
CORP. NAME
FEDERAL INCOME TAX CALENDER
CORP. ADDRESS
YEAR
CITY
STATE
ZIP
FISCAL YEAR MONTH END
OWNER’S NAME
ADDRESS
PHONE
CITY
STATE
ZIP
LOCAL PHONE NO.
NATURE OF BUSINESS
If subsidiary, list name of parent Co.
Type of ownership: ____ Individual Proprietorship ____ Corp ____ Partnership ___ Non-Profit ___ Assoc.
Does your business have employees? ________ Number in Brook Park _________
Is payroll tax remitted for resident employee/s? (RESIDENCY TAX) ______ YES ______ NO
Has company previously filed under another name? ________ Provide Name __________
If partnership, association or other unincorporated joint business venture, list names, and addresses of all
partners, statutory agents, associates or members in the venture. If partnership, will partners file
separately? ______ YES ______ NO
NAME ADDRESS CITY STATE ZIP S.S. NO.
1.
2.
3.
Accountant’s Name
Address
City
State
Zip
Phone No.
Do you own property in Brook Park? ________ YES _______ NO
If answer is Yes, list property location
Do you pay rent on any offices or building in Brook Park? _______ YES ______ NO
If answer is Yes, list name(s) & address(es) of Landlord(s)
Mail Business Net Profit Tax Returns to:
Mail Employer Withholding Forms to:
Name
Name
Care of
Care of
Address
Address
City
St
Zip
City
St
Zip
Supplemental Information – Brook Park Resident Companies must complete this section:
P.U.C.O. Number_________________ (Attach Authorization) 401(k) Plan YES____ NO____
Outside Landscaping Service
Waste Removal Service
Outside Janitorial Service
I HEREBY CERTIFY THAT ALL INFORMATION AND STATEMENTS HEREIN ARE TRUE AND
CORRECT.
___________________________ ___________________________ ____________________________
Signature (Type or Print)
Title
Date
ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL AND IS USED FOR CITY INCOME TAX
PURPOSES ONLY.
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