Business Registration FormBUSINESS REGISTRATION FORM                           City of Newark Income Tax Division       Phone: 740‐670‐7580 
                                                                PO Box 4577                                                             Fax: 740‐670‐7581 
   Check the appropriate taxing authority 
                                                                Newark OH 43058                                                    Website: www.newarkohio.gov 
   City of Newark ___ Etna JEDZ2 ___                                                                     Email: citytax@newarkohio.net        
   
   Etna JEDZ1 ___     Pataskala JEDD ___ 
                                                
   USE A SEPARATE FORM FOR EACH AUTHORITY 
                        
 ACCT #: ____________________ 

 Please assist us in completing your account information by mailing, faxing, or emailing this completed form with any 
 additional attachments within 10 business days. Thank you for your cooperation. 

 1. Name                                                                                                                  Phone ________________________                      

 2. Trade Name (DBA) ________________________________________                                                             Fax __________________________                       

 3. Federal EIN or Soc Sec # ____________________________________                 Email ________________________ 

 4. Address ______________________________________________________________________________________ 

 5. Name and address where tax forms are to be mailed (if different from above) 

 _______________________________________________________________________________________________ 

 6. Type of business ownership (check one) 

 **Non‐resident sole proprietor (Schedule C) ____                                 
 **If sole proprietor, please provide name and residence address of owner. 

 Partnership ____     Corporation ____                    Other (please specify) ___________________________________    

 7. Nature of business conducted ______________________________________________________________________ 

 8. Date business and/or withholding began in this taxing jurisdiction _________________________________________ 

 9. Is your company only withholding Newark income tax as a courtesy for resident employees?  YES ____    NO ____ 

  If yes, please answer questions 10 and 11. If no, proceed to Line 12 

 10   Is WORKPLACE TAX also being withheld for this employee                     YES ____                                  NO ____ 

 11. If your employee is working from home, please state the nature of duties performed so we may determine if your 
 company will have a Net Profit liability           _____________________________________________________________ 

 12. When does your fiscal year end—must be the same as your federal return (month and day) ____________________ 

 13. Will you be using subcontractors?   If yes, the following will be required: 

 ‐‐A listing of subcontractors, to include the business name, address, contact name, phone number, and nature of work 
 being performed. 

 14. If you operate more than one place of business or own rental property, please provide a listing of the applicable 
 addresses. 

 Name of Contact Person (Please print) __________________________________________________________________ 

 Contact Person Signature Date ________________________________________________________________________