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Complete this form and send to:
Cincinnati Income Tax Division
805 Central Avenue Suite 600
Cincinnati, OH 45202-5799
CITY OF CINCINNATI INCOME TAX DIVISION Phone: (513) 352-2546 Fax: (513) 352-2542
NEW ACCOUNT APPLICATION Website: www.cincinnati-oh.gov/citytax
COMPANY NAME: CINCINNATI LOCATION:
(If different from Company Address)
DBA:
STREET ADDRESS: STREET ADDRESS:
CITY/STATE/ZIP CODE: CITY/STATE/ZIP CODE:
PHONE NO: FAX NO: LOCAL PHONE NUMBER:
SOC. SEC. NO: FED. ID NO: EMAIL ADDRESS: _____
CONTACT PERSON: LOCAL CONTACT PERSON:
Type of Business Entity (Check the box that applies to your business):
Corporation S-Corporation Partnership Sole Proprietorship
LLC Single Member LLC Joint Venture Trust
Non-Profit Other(specify) __________________________________________
Nature of Business:______________________________ Fiscal Year End(Jan through Dec):
Will your company require a business net profit account to report taxable income earned in Cincinnati? YES NO
Date Business Activity began in Cincinnati: _________________
Will you have employees subject to Cincinnati Withholding Tax? YES NO Voluntary Withholder
Date Withholding Activity began in Cincinnati: _______________
Quarterly payments totaling < $2,400 Per Year
Monthly payments totaling $2,400 - $11,999 Per Year
Semi-Monthly payments totaling > $12,000 Per Year
Name of Payroll Company that you use (if applicable):
Payroll Company contact and phone number: ______________________________________________________
CORPORATE OFFICERS (if applicable):
NAME RESIDENTIAL ADDRESS SOC. SEC. NO.
PRESIDENT: ___________________________ _____________________________________ ______________
TREASURER: __________________________ _____________________________________ ______________
PARTNERSHIPS (attach additional sheets if necessary):
PARTNER’S NAME RESIDENTIAL ADDRESS SOC. SEC. NO.
__________________________________ ___________________________________________ ______________
__________________________________ ___________________________________________ ______________
SOLE PROPRIETORSHIP (including Single Member LLC):
OWNER’S NAME RESIDENTIAL ADDRESS SOC. SEC. NO.
__________________________________ ___________________________________________ ______________
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