Business Income Tax  Questionnaire 
 The following information is required to determine your City of Dayton, Ohio income tax liability, if any, and to set up your account if required. 
 
                                           Type of Tax Filing: (check all that apply) 
 
                                           1.        Employee Withholding                  FEIN #                                                     
 
                                           2.        Corporate Earnings                    FEIN #                                                     
 
                                           3.        Individual Ownership Earnings         SSN #                                                      
 
                                           4.        Partnership Earnings                  FEIN #                                                     
 
 Company Name                                                                             Phone #                                                     
 Mailing Address                                                  City                              St.______  Zip                                    
 Local Business Address                                           City                              St.______  Zip                                    
 Check the jurisdictions that we administer that you operate  in: 
   Dayton City Limits Dayton Wright Brothers Airport  Dayton International Airport                   NONE 
 
 Date Business Started in Our  Taxing Jurisdiction                                                                                                   
 Your Accounting Period?    Calendar Year            or Fiscal Year ending on                                                                         
 
 Withholding Information *Quarterly Withholding cannot exceed $600.00 
                                                                                                                                                      
 ■ Do you have employees?   Yes   or No    Date First Employee Started Working in Our  Jurisdiction                                                   
 
 ■ Do you submit withholdings QUARTERLY* or  MONTHLY?                                                                                                 
 
 ■ Is this a courtesy withholding for your employees who are residents of the above cities only?   Yes       or No 
                                                                                                                                                      
 Do you rent or sublease property or space in the Dayton jurisdiction to another business or individual?   Yes       No 
 If so list Names, Addresses, and Tax ID below. If Yes, do they have employees working at that  location?    Yes     No 

 Do you use Subcontractors?  Yes  No       If so list Names, Addresses, and FEIN or Social Security Numbers below. 
                                                                                                                                                      
 If you have filed returns with our office before, show Name and Tax ID #s used, and for what tax years you filed. 
                                                                                                                                                      
 Full name of Owner of Company                                                                                                                        

 If this is a change of ownership, please provide the date of change, the name, address, and phone number of former owner 
                                                                                                                                                      
 If you are not liable to pay taxes in our jurisdiction, please explain  why. 
                                                                                                                                                      
 Signature                                            Title                                                  Date                                     
 Thank you for your cooperation in this request. For more tax information is available at www.daytonohio.gov 
 Please return by MAIL or by FAX to: City of Dayton, Division of Revenue & Taxation, 101 West 3rd Street, P.O. Box 2806, Dayton, Ohio 45401 
                         (937) 333-3500 ~ Fax (937)  333-4280 
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