Individual Registration Form
                                                                                            Phone 330-263-5226
                                                                                            Fax 330-263-5262

Names:

Primary Social Security Number          First Name                Middle                    Last Name

Spouse Social Security Number           First Name                Middle                    Last Name

Primary date of birth:                                Spouse date of birth:

Residence Address Information:

Number                 Street Name                                         Apt./Suite #              PO Box

City                           State                              Zip Code            Email:

Date moved into this address:                                     Phone #: 

Do you own or rent your home?  Please  Own                       Rent

If renting please give Landlord's name, address, and phone number:

Previous Address Information:

Number                 Street Name                                         Apt./Suite #              PO Box

City                           State                              Zip Code

Date moved into this address:

Employment information:
Are you employed?      Yes     No                     Is your spouse employed?              Yes      No
Are you retired and/or have no taxable income?        Yes         No       If yes, date you retired:
Is your spouse retired and/or have no taxable income?             Yes      No               If yes, date you retired:
Do you have income reported on Federal Schedules C, E, or F?      Yes      No
Does your spouse have income reported on Federal Schedules C, E, or F?     Yes              No
Do you and/or your spouse own rental property?        Yes         No
If yes, please list properties and tenant names if located inside Wooster city limits 

Mail form to:
City of Wooster Income Tax Department
PO Box 1088
Wooster, OH 44691