INDIVIDUAL REGISTRATION 
          
         Please mail completed form to: City of Wooster Income Tax Department 
                                              PO Box 1088, Wooster, OH  44691  
         Or fax to: 
         (330)-263-5262
          
         Date moved into the City of Wooster _________________________    
          
         Phone No.__________________  
          
         Primary Name ___________________________    Primary social security #_____-____-______  
          
         Spouse Name ____________________________    Spouse social security  #_____-____-______ 
          
         Street Address _______________________________________  Apt #______________ 
          
         City _______________________________  State __________ Zip Code ____________ 
          
         LIST ALL OTHER RESIDENTS IN HOUSE (        AGE 18 AND OLDER) 
          
         NAME                                      SOCIAL SECURITY #     AGE  
                                                                             
         ______________________________            __________________      _____ 
          
         ______________________________            ___________________     _____ 
          
         ______________________________            ___________________     _____ 
          
         Check All Applicable Boxes For Sources of Income: 
                        My only income is wages from an employer. 
                        I am self-employed.  Please list business name and address. Please check IRS 
                        filing method:     Sole proprietor          Other – we will contact you to register 
                        your business 
          
                        _________________________________________________________ 
                        Rental Income 
                        Social Security/Pension 
                        Other  
          
         Signature _______________________________________  Date____________________ 
                        I declare that to the best of my knowledge the above information is true and correct.