This form can be filed on our website www.columbustax.net "New Account Setup"
                     City of Columbus, Income Tax Division 
    Form
        IT-47        Request for Municipal Income Tax Account for Columbus
 PART A          GENERAL INFORMATION
                                                                                     Business Type:
Taxpayer federal EIN/FID/SSN           Reporting agent's federal EIN                 C-Corporation (1120)                                Domestic Help
                                                                                     S-Corporation (1120S)                               Non-Profit
                                                                                     Partnership (1065)                                  Government Employer
Taxpayer's legal name
                                                                                     Trust (1041)                                        Courtesy Employer
                                                                                     LLC filing as Partnership                           Sole Proprietor 
Mailing address for business tax returns and correspondence                          LLC filing as Corporation                           (Schedule C)
                                                                                     Single Member LLC (Disregarded Entity) 
                                                                                     Please identify owner/member:
City                                                      State        Zip code
                                                                                     Name:                                               FID/SSN:
                                                                                     Business type (corporation, partnership, or individual):
Mailing address for payroll tax returns and correspondence

City                                                      State        Zip Code      Date business started in our area Date of 1st payroll for City of Columbus

Trade name/DBA                         Fiscal year end (if applicable)               Approximate monthly payroll for employees           Pay cycle (weekly, 
                                                                                     working in the City of Columbus                     biweekly, monthly etc.)
                                                                    Payroll Service
Name of payroll service or employee leasing company (if any)
                                                                    Leasing Co.      Nature of business (i.e. computer, consulting, etc.)

 PART B          CONTACT INFORMATION  CONTACT INFORMATION

Name of President, CEO, Tax Matters, Partner or Trustee                Home address of President, CEO, Tax Matters, Partner or Trustee

SSN of President, CEO, Tax Matters Partner, or Trustee                 City                                                              State                      Zip Code

Name of Officer or Partner in charge of payroll                        Home address of President, CEO, Tax Matters, Partner or Trustee

SSN of Officer or Partner in charge of payroll                         City                                                              State                      Zip Code

Name of internal payroll tax contact   Payroll tax contact's title  E-mail address                      Payroll tax phone #                  Payroll tax fax #

Name of internal business tax contact  Business tax contact's title E-Mail address                      Business tax phone #                 Business tax fax #

 PART C          GREATER COLUMBUS METROPOLITAN AREA ADDRESSES
List all Columbus area addresses where you have employees working. Consulting firms should include the addresses of client locations if the firm has employees physically working at 
client sites (indicate if address given is a client site). Construction firms should include job site addresses (indicate if address given is a job site). Businesses with a significant number of 
field employees who work at multiple customer sites in a week should list only their actual locations, and in one of the boxes below indicate the geographic area served by their field 
employees (for example: “Field employees working out of our Columbus office serve our Ohio and Indiana customers”). Attach a separate sheet if more space is needed.

Street address                                                                  City                                                     State                      Zip Code

Street address                                                                  City                                                     State                      Zip Code

 PART D          SPECIAL INSTRUCTIONS FOR PARTNERSHIP AND S-CORPORATIONS
Attach a separate sheet showing the name, SSN/FID and address of each partner or shareholder.  Identify owner/member’s name, address, and FID No. (SSN if 
an individual).  If the owner is a corporation, include an officer and SSN.  If a partnership, include the tax matters partner with SSN.
 PART E          SIGNATURE OF PERSON COMPLETING FORM                                                                                     Rev. 9/2/2011Print Form

Signature                                                                                      Date                                          Reset Form