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City Of Sharonville                                www.sharonville.org                                               Income Tax Office

11641 Chester Road – Sharonville, OH  45246-2803                                     Phone: (513) 563-1169  Fax: (513) 588-3969

                    CITY OF SHARONVILLE COURTESY WITHHOLD REGISTRATION FORM

Name of Business                                                                 Federal ID #                                

Doing Business As                                                                Phone # 

Name & Title of Payroll Contact                                                  Fax #                                       

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 Employee Reports To Work                                   Address Employee Reports To Work

Employee Name                                SS#                   Employee Name                                  SS#
                                                              
Home Address                                                       Home Address
                                                              
Address Employee Reports To Work                                   Address Employee Reports To Work

                  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-W  REV. 10-09