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                                                            RENTAL INCOME TAX   
CITY OF KETTERING - INCOME TAX DIVISION                      QUESTIONNAIRE 
   P.O. Box 293100      Kettering, OH 45429                            
 Phone: 937.296.2502    Fax: 937.296.3242         Date:                                                                   
           www.ketteringoh.org                                         
                                                  Kettering Account Number:                                               
                                                                       
Please complete and return this rental income tax questionnaire to our office by the due date 
stated. You may mail or fax the completed questionnaire to our office. Please contact us with any 
questions you may have or visit our website to obtain forms and additional information.   
 
Owner Name:                                                                                                          
Spouse Name:                                                                                                         
Owner Address:                                                                                                       
City, State, Zip Code:                                                                                               
Owner SSN:                                            Spouse SSN:                                                    
Telephone #:                                          Cell Phone #:                                                  
Email Address:                                                                                                       
 
If  you  are  a  Kettering  resident,  you  must  list  all  of  the  rental  properties  you  own  in  the  space 
provided  below.  Non-residents  need  to  list  only  those  properties  which  are  located  in  The  City  of 
Kettering.  In  addition,  if  you  have  purchased  a  Kettering  property  not  intended  for  lease  or  rent or  for 
resale purposes only, please write an explanation below. Note: Additional properties may be listed on the 
reverse side of this form or on a separate sheet. 
 
Street Address                                               Date Acquired  # of Units    Rented Y / N 
1)                                                                              

2)                                                                              

3)                                                                              

4)                                                                              

5)                                                                              

6)                                                                              

7)                                                                              

8)                                                                              

Signature:                                                             Date:                                                
 
Spouse Signature:                                                      Date: