City Of Sharonville Income Tax Office                   www.sharonville.org                            Email: taxoffice@cityofsharonville.com 
 
11641 Chester Road – Sharonville, OH  45246-2803                                         Phone: (513) 563-1169  Fax: (513) 588-3969 
 
               COURTESY OR WORK-FROM-HOME EMPLOYEE WITHOLDING REGISTRATION FORM 
 
Name of Business                                                                    Federal ID #                                  
 
Doing Business As                                                                   Phone #                                     
 
Name & Title of Payroll Contact                                                     Extension #                                   
 
E-Mail Address                                                                                                                  
 
Mailing Address                                                                                                                 
 
Do you use a payroll company to submit withholding payments?        Yes      No   Frequency:       Monthly      Quarterly 
 
If yes, list name of payroll company                                                Start Date of Withholding                   
 
Please list employee name, social security number, home address and local work address for each employee: 
 
Employee Name                                  SS#                   Employee Name                             SS#       
 
Home Address                                                         Home Address 
 
Address of Employee Work Location                                    Address of Employee Work Location      
 
Employee Name                                  SS#                   Employee Name                             SS#       
 
Home Address                                                         Home Address 
 
Address of Employee Work Location                                    Address of Employee Work Location 
 
                 Please attach a separate paper with additional names, social security numbers and addresses if needed. 
 
I do hereby certify that to the best of my knowledge the above information is true, correct and complete.  Additionally, I understand that all 
information contained herein is confidential. 
 
Signature                                                            Title                                     Date 
                                                                                                                    FORM RF-C.WFH  REV. 09-22