Business Questionnaire - City of Oakwood Income Tax Department

1. Federal I.D. / Soc. Sec. Number:

2. Company Income Tax Filing Type for federal tax purposes:

Sole-Proprietorship Partnership Corporation S-Corp Other (Please Specify)

3. Calendar Year or, Fiscal Year Ending

4. Company / Business Name:

5. Business Address:

6. Contact Person:

Telephone #

Fax #

7. Nature of Business:

Billing Address:

(If different from above)

9. Do you have employees? YES NO

IF YES:

a. Do employees perform work or services in Oakwood? YES (Complete #12) NO (Complete #11)

b Are employees remote workers? YES (List names/addresses below in #12) NO

10. Remit: MONTHLY QUARTERLY (See ORC 718.03(B)(1)(a) or (b) for remittance requirements)

11.

If you are withholding only as a courtesy for those employees who reside in Oakwood, please list name and address of employee.

(Note that City of Oakwood residents will have either a 45419 or 45409 zip code.)

12. Work in Oakwood is: Ongoing Occasional/Project Specific

Start Date

Estimated Ending Date (if project specific)

Name and address of Oakwood jobsite

Number of employees working in Oakwood Number of subcontractors working in Oakwood

* A complete listing of subcontractor names, addresses, Federal ID numbers, and phone numbers must be provided prior to the beginning of each project. A summary including payments to each subcontractor must be provided at the completion of a specific project or annually if work is ongoing.

I certify the above information to be true, complete and accurate.

AUTHORIZED SIGNATURE

TITLE

DATE

E Mail Address (To be used for account number notification purposes only.)