WITHHOLDING AND BUSINESS REGISTRATION 

                                                  Income Tax Division 
                                                         P O Box 1668 
                                                  Stow, Ohio 44224 
                                                Phone: (330) 689-2849  Fax (330) 689-2847 
                                                  www.stowohio.org 

Company Name                                        Phone #: 

DBA:                                                Fax #: 

Local business or job-site address 

Mailing Address 
  (if different from above) 
Initial date of business in Stow 

Nature of business                                  Number of employees in Stow 

Federal Identification #                           NAICS # 
** THE FEDERAL ID # IS ALSO USED AS THE ACCOUNT # ** 
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                                    CHECK BUSINESS TYPE 
Sole Proprietor                                          Corporation  
Partnership                                              Non-Profit Corp         
S-Corporation                                            Other  
Estate or Trust  

For Corporation, list full name, address, social security #’s and phone #’s of each Officer 
1) 
2) 
3) 

For Partnership Entities, list full names, addresses and social security #’s and phone #’s of each partner 
1) 
2) 

For Sole Proprietor, list full name, address, social security # and phone # 

Accounting period:  Calendar Year                  Fiscal Year          Month ending  
Company’s Accountant, address and phone #  
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                                   PAYROLL INFORMATION 

Will you be withholding employment taxes                  Yes                    No 
Will the withholding be more than $200 per month          Yes                    No 
Will you only be withholding as a courtesy for a Stow resident   Yes             No 
If courtesy withholding, please give Name, Address & SSN 

Date withholding will begin  
Do you presently use an outside payroll service           Yes                    No 
If yes, please provide name of payroll service  
Do you lease employees from an employment agency          Yes                    No 

Full name, address and phone # of the person(s) or entity to whom your Stow location pays rents 

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                                 ABOVE INFORMATION IS REQUIRED 
                                 ALL INFORMATION IS CONFIDENTIAL