City of Brook Park, Tax Department  
                                                             6161 Engle Rd., Brook Park, OH 44142 
                                                                                Phone (216) 433-1533 
                                                                               Fax (216) 433-0822 
      CITY OF BROOK PARK BUSINESS & CORPORATION REGISTRATION FORM 

DATE MOVED/STARTED IN CITY                             FED. I.D. NO.    
LOCAL BUS. NAME                                      SOC. SEC. NO.  
LOCAL BUS. ADDRESS                                     CORP. PHONE NO.   
CITY                      STATE          ZIP           ACCOUNT PERIOD USED FOR 
CORP. NAME                                             FEDERAL INCOME TAX CALENDER 
CORP. ADDRESS                                          YEAR    
CITY                      STATE         ZIP            FISCAL YEAR MONTH END       
OWNER’S NAME
ADDRESS                       PHONE  
CITY                      STATE         ZIP
LOCAL PHONE NO.            

NATURE OF BUSINESS
If subsidiary, list name of parent Co.  

Type of ownership: ____ Individual Proprietorship ____ Corp ____ Partnership ___ Non-Profit ___ Assoc. 
Does your business have employees? ________ Number in Brook Park _________ 
Is payroll tax remitted for resident employee/s? (RESIDENCY TAX) ______ YES ______ NO  
Has company previously filed under another name? ________ Provide Name __________ 
If partnership, association or other unincorporated joint business venture, list names, and addresses of all 
partners, statutory agents, associates or members in the venture. If partnership, will partners file 
separately? ______ YES ______ NO 
NAME ADDRESS CITY STATE ZIP S.S. NO. 
1.
2. 
3.
Accountant’s Name                            Address
City                       State             Zip              Phone No. 
Do you own property in Brook Park? ________ YES _______ NO 
If answer is Yes, list property location    
Do you pay rent on any offices or building in Brook Park? _______ YES ______ NO 
If answer is Yes, list name(s) & address(es) of Landlord(s)  

Mail Business Net Profit Tax Returns to:     Mail Employer Withholding Forms to: 
Name                                      Name 
Care of                                      Care of   
Address                                      Address
City         St           Zip                City            St  Zip  

Supplemental Information – Brook Park Resident Companies must complete this section: 
P.U.C.O. Number_________________ (Attach Authorization) 401(k) Plan YES____ NO____ 
Outside Landscaping Service
Wasovalte RemService 
Outside Janitorial Service

I HEREBY CERTIFY THAT ALL INFORMATION AND STATEMENTS HEREIN ARE TRUE AND 
CORRECT. 

___________________________   ___________________________   ____________________________ 
Signature (Type or Print)     Title                          Date

ALL INFORMATION PROVIDED ON THIS FORM IS CONFIDENTIAL AND IS USED FOR CITY INCOME TAX 
PURPOSES ONLY.