TAX OFFICE USE ONLY:                                                               
ATTN: READING SCHOOL PERSONNEL                                                        ACCOUNT# ______________ 
                                                                                                        (CITY WILL ASSIGN)             
THIS  FORM  MUST  BE  COMPLETED  AND 
SIGNED  BY  THE            CITY OF READING                 
TREASURER’S OFFICE              BEFORE      ANY 
                                                                                      Melvin T. Gertz, Treasurer 
RESIDENT  CAN  REGISTER  THEIR  CHILDREN         City of Reading, Ohio 
FOR SCHOOL                                                                             (513) 733-0300 
                                                        INCOME TAX BUREAU 
                                                                                       (513) 842-1016 Fax 
__________________________________                      1000 MARKET STREET 
Signature – Deputy Treasurer       Date                 READING, OHIO 45215 

                                           RESIDENT REGISTRATION QUESTIONNAIRE 
                                            PLEASE COMPLETE AND RETURN WITHIN 10 DAYS 
 
NAME:  __________________________________     Social Security # _____/____/______ Date Of Birth: ___/___/___ 
SPOUSE: ________________________________                 Social Security #_____/____/______  Date Of Birth: ___/___/___ 
                           (IF APPLICABLE) 
ADDRESS: ________________________________   APT #_______  E-MAIL:________________________________ 
TELEPHONE# (Home)_______________  (Work)_________________  DATE MOVED INTO READING: ____/____/____ 
1.  ARE YOU A STUDENT?   ___ YES ___ NO                  ___ HIGH SCHOOL   ___ COLLEGE  
    IF YOU ARE A STUDENT AND WORKING PART-TIME COMPLETE SECTION 3 ONLY, SIGN THE BACK AND RETURN.     
2.  ARE YOU RETIRED AND RECEIVE A PENSION OR SOCIAL SECURITY ONLY?   ___ YES ___ NO 
    IS SPOUSE RETIRED ON A PENSION OR SOCIAL SECURITY ONLY?                        ___ YES ___ NO 
    ARE YOU ON A DISABILITY?                            ___ YES ___ NO     ___ SHORT-TERM  ___ PERMANENT 
    IS SPOUSE ON A DISABILITY?                          ___ YES ___ NO     ___ SHORT-TERM  ___ PERMANENT   
    ARE YOU UNEMPLOYED?                                 ___ YES ___ NO     ON WELFARE? ___ YES ___ NO     
    IS SPOUSE UNEMPLOYED?                               ___ YES ___ NO     ON WELFARE? ___ YES ___ NO     

     (If Answer is “NO” to Question 2 Please Complete Sections 3, 4, 5 and 6 as applies to You and Spouse) 
3.                                              EMPLOYMENT INFORMATION 
                           YOU                                                     SPOUSE 
 A) FULL-TIME EMPLOYER: ______ ________________           A) FULL-TIME EMPLOYER: ______ ________________  
     ADDRESS: __________________________________              ADDRESS: __________________________________ 
     CITY WHERE EMPLOYED: _____________________               CITY WHERE EMPLOYED: _____________________ 
     OCCUPATION: ___________________________ ___              OCCUPATION: ___________________________ ___ 
     CITY TAX WITHHELD: ________________________              CITY TAX WITHHELD: ________________________ 
 B) PART-TIME EMPLOYER: ______________________            B) PART-TIME EMPLOYER: ______________________ 
     CITY WHERE EMPLOYED: _____________________               CITY WHERE EMPLOYED: _____________________ 
     OCCUPATION: ___________________________ ___              OCCUPATION: ___________________________ ___ 
     CITY TAX WITHHELD: ________________________              CITY TAX WITHHELD: ________________________ 
 C) SELF-EMPLOYED? YES ___  NO ___                        C) SELF-EMPLOYED? YES ___  NO ___ 
      NAME OF BUSINESS: ________________________               NAME OF BUSINESS: ________________________ 
      FEDERAL ID NO: (If Applicable) _________________         FEDERAL ID NO: (If Applicable) _________________ 
      BUSINESS ADDRESS: ________________________               BUSINESS ADDRESS: ________________________ 
      PHONE: _______________ FAX: _______________              PHONE: _______________ FAX: _______________ 
      NAME(S) OF OFFICERS: _____________________               NAME(S) OF OFFICERS: _____________________ 
     ___________________________________________              ___________________________________________ 

                                                          1 OF 2 
                                                           

                                      EMPLOYMENT INFORMATION (Cont.) 
                               YOU                                 SPOUSE 

PREVIOUS EMPLOYER(s) TO 3A IF WHILE A READING   PREVIOUS EMPLOYER(s) TO 3A IF WHILE A READING 
RESIDENT: ____________________________________  RESIDENT: ____________________________________ 
CITY WHERE EMPLOYED: _______________________    CITY WHERE EMPLOYED: _______________________ 
CITY TAX WITHHELD: ___________________________  CITY TAX WITHHELD: ___________________________ 
                                                 
                                              PROPERTY INFORMATION 
4. DO YOU OWN THE PROPERTY IN WHICH YOU LIVE:          YES______ NO ______ 
    IF “NO” ARE YOU RENTING?                           YES______ NO ______ 
    LIST NAME AND ADDRESS OF LANDLORD: ___________________________________________________________ 
     ________________________________________________________________________________________________ 

5. DO YOU OWN RENTAL PROPERTY (S) IN READING?          YES______ NO ______ 
    ADDRESS(ES) OF RENTAL PROPERTY (S) IN READING: ________________________________________________     
__________________________________________________________________________________________________ 
PROPERTY TYPE:   ____ SINGLE FAMILY   ____ DUPLEX   ____ APARTMENT   ____ TRAILER   ____ COMMERCIAL 
   
PROPERTY TYPE:   ____ SINGLE FAMILY   ____ DUPLEX   ____ APARTMENT   ____ TRAILER   ____ COMMERCIAL 

 DO YOU OWN RENTAL PROPERTY (S) OUTSIDE READING?       YES______ NO ______ 
 ADDRESS OF RENTAL PROPERTY OUTSIDE READING: 
   
   
6.                                         OTHER HOUSEHOLD MEMBERS 
           Please List ALL Members 18 Years and Older Living In Your Residence 
NAME       D.O.B.            SOCIAL SECURITY #                     EMPLOYER NAME (If Applicable) 

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________ 

7. IF REGISTERING FOR READING SCHOOLS, PLEASE ATTACH COPY OF LEASE OR LETTER FROM LANDLORD.   
    NAME(S) OF CHILDREN:_________________ __________________________________________________ 

    NAME OF SCHOOL(S) THEY WILL ATTEND:___________________________________________________ 
 
I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. 
 
___________________________________________    ______________________________ 
Signature                                       Date 
 
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