WITHHOLDING AND BUSINESS REGISTRATION 

                                                    Income Tax Division 
                                                          P O Box 1668 
                                                     Stow, Ohio 44224 
                                                 Phone: (330) 689-2849  Fax (330) 689-2847 
                                                     www.stowohio.org 

Company Name                                       P hone #: 

DBA:                                               Fax #: 

 Local business or job-site address  

 Mailing Address 
   (if different from above) 
 Initial date of business in Stow  

 Nature of business                                Number of employ          ees in Stow 

Federal Identification #                           NAICS # 
 ** THE FEDERAL ID # IS ALSO USED AS THE ACCOUNT # **
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                                      CHECK BUSINESS TYPE
Sole Proprietor                                    Corporation
Partnership                                        Non-Profit Corp
S-Corporation                                      Other
Estate or Trust

 For Corporation, list full name, address, social security #’s and phone #’s of each Officer 
1) 
2) 
3) 

 For Partnership Entities, list full names, addresses and social security #’s and phone #’s of each partner 
1) 
2) 

 For Sole Proprietor, list full name, address, social security # and phone # 

 Accounting period:  Calendar Year                  Fiscal Year          Month ending  
 Company’s Accountant, address and phone #  
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                                     PAYROLL INFORMATION 

 Will you be withholding employment taxes                  Yes                           No 
 Will the withholding be more than $200 per month          Yes                    No 
 Will you only be withholding as a courtesy for a Stow resident   Yes             No 
 If courtesy withholding, please give Name, Address & SSN 

 Date withholding will begin  
 Do you presently use an outside payroll service           Yes                    No 
 If yes, please provide name of payroll service  
 Do you lease employees from an employment agency          Yes                    No 

 Full name, address and phone # of the person(s) or entity to whom your Stow location pays rents 

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                                   ABOVE INFORMATION IS REQUIRED 
                                   ALL INFORMATION IS CONFIDENTIAL