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KIM R. PEREZ                                                                                                                                                                    City of Canton
TREASURER, CITY OF CANTON
cantonincometax.com
                                                                                                           INCOME TAX DEPARTMENT
Hours: 8:00-4:00
Monday thru Friday                                                                                                            MAILING ADDRESS:               PO BOX 9940, CANTON, OHIO 44711
                                                                                                                                    OFFICE ADDRESS:  424 MARKET N., CANTON, OHIO 44702
                                                                                                                                                                                PHONE (330) 430-7900

                                                     Business & Corporation 

                                                     BusinessInformation& CorporationSheet
                                                                                       Division of Compliance

         City of Canton       JEDD - FP       JEDDInformation- TWR/SS       JEDD - CD      SheetJEDD - SM       JEDD - TSG      JEDD - TGAB
                                                                                       Division of Compliance

Owner’sOwner’s Name____________________________________Name____________________________________ TelephoneTelephone NumberNumber _________________________

Owner’sOwner’sAddress__________________________________Address__________________________________SocialSocialSecuritySecurityNumber______________________Number  

                                City___________________________ State____________ Zip___________City___________________________ State____________ Zip___________

BusinessBusiness Name______________________________________Name______________________________________ FID.FID. NumberNumber (if(if corporation)_______________corporation) 

BusinessBusinessAddress____________________________________Address____________________________________BusinessBusinessPhonePhone __________________________

                                City___________________________ State____________ Zip___________City___________________________ State____________ Zip___________

NatureNatureofofBusinessBusiness____________________________________________________________________________________________________________________________________________________

If Subsidiary, List Name of Parent Co  If Subsidiary, List Name of Parent Co___________________________________________________________

Type of Ownership (Please Circle)Type of Ownership (Please Check)

           Sole Proprietorship        Sole Proprietorship    Partnership        Partnership    Not-For-ProfitNot-For-ProfitCorp       Corp   Corporation        Corporation     AssociationAssociation

WillWillYourYourBusinessBusinessHaveHaveEmployees?    Employees?    Yes     No         Yes      ContractNo        Workers?    ContractYes    Workers?      NoYes       No

DateDateStartedStartedororMovedMovedtotoCantonTaxing Districtor Dateor DateBusinessBusinessActivityActivityBeganBeganin Cantonin Taxing___________________________District 

If partnership, association or other unincorporated joint business venture, please list names and address of allIf partnership, association or other unincorporated joint business venture, please list names and address of all  
partners,partners,associatesassociatesorormembersmembersininventureventureononbackbackofofform. form. IfIfpartnership,partnership,willwillpartnerspartnersfilefileseparately?  separately?  Yes   Yes   NoNo
AccountingAccountingPeriodPeriodUsedUsedforforFederalFederalIncomeIncomeTaxTaxPurpose:Purpose:
                                                                    CalendarCalendarYearYearEndingEndingDecDec31      31      FiscalFiscalYearYearEndingEnding________________________________________ 

Accountant’s Name                         Address                                City                      State                      ZipAccountant’s Name                         Address                                City                      State                      Zip

 __________________________________________________________________________________________

IfIfyouyouoperateoperateanyanyotherotherbusinessbusinesswithinwithinororoutsideoutsidethethecitycityofofTaxingCanton,District,pleasepleaselistlistbelow.below.

DoDoyouyoupaypayrentrentononanyanyofficesofficesororbuildingsbuildingsininCanton?         Canton?        Yes    Yes      NoNo

                                                                                                                        Name                                Address               CityName                                Address               City

If yes, please list name(s) & address(es) of landlord(s)  
If yes, please list name(s) & address(es) of landlord(s) _____________________________________________

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Address where tax forms and other correspondence are to be mailed

Name _________________________________________________________

Care of ________________________________________________________

Address _______________________________________________________

City______________________________ State___________ Zip__________

                           Partners, Associates or Members in Joint Venture

Name                                        Address                          City State Soc Sec #

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

                                                    Other Business

Business NameBusiness Name                  Address Address Nature of Business    Nature of BusinessTaxing District

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Under penalties of perjury, I declare that I have examined this questionnaire and accompanying documents, and, to the best of my knowledge
and belief, the information provided herewith is true, correct, and complete.

Signature_______________________________________________ Title____________________________ Date____________________________