INDIVIDUAL INCOME TAX QUESTIONNAIRE
CITY OF OAKWOOD - INCOME TAX DEPARTMENT
30 PARK AVE
DAYTON, OHIO 45419-3400
TEL # (937) 298-0531 FAX # (937) 297-2940
(Please return completed form within 15 days of receipt)
1.
Name
Soc Sec #
Birthdate *
Spouse
Soc Sec #
Birthdate *
*Please provide birthdate only if you were under the age of eighteen (18) years at any time in the previous year.
Present Street Address
Date Moved Into Oakwood
City
State
Zip Code
2.
Taxpayer’s Employer
Employer’s Address
Is employer withholding city tax?
YES
NO
If yes, identify city
3.
Spouse’s Employer
Employer’s Address
Is employer withholding city tax?
YES
NO
If yes, identify city
4.
If Self-Employed:
Business Name
Nature of Business
Do you have employees?
YES
NO
Federal Identification #
5.
Do you own rental property?
YES
NO
If yes, list address of each rental property
6.
Other income (partnership, estate, trusts, etc)
7.
Name and social security number of other members of the household age 18 or over (excluding self and spouse)
8.
Do you employ domestic help or contract for services (landscaping, snow removal, etc.) at your residence?
YES
NO
If yes, list name, address and date hired:
9.
If you are retired and have no earned income, please check here
Signature
Date
Spouse’s Signature
Date
Home Telephone
Work Telephone