City of Lorain Income Tax Department 
                              605 W. Fourth St. Lorain Ohio  44052 

                           Phone:  (440) 204-1002 Fax: (440) 204-1006 

                                incometax@cityoflorain.org 

[[Date Letter Printed]]                                        Account number: [[File Number]] 

[[Block Address]] 

According to Lorain's Income Tax Ordinance, all companies doing business in Lorain must register 
with this office.   

· Net profit/loss taxes on the Lorain activity are to be filed and paid at the end of the calendar or 
  fiscal year, whichever is applicable.   

· Employee withholding taxes are to be filed and paid quarterly.  

· The City's tax rate is 2.5%.  (prior to 1-1-2013 tax rate was 2%) 

· Employee W-2 Forms, 1099 Forms and the Employer Reconciliation of Withholding Form (W-
  3) are due by January 31st following the year in which the income was earned. 

· Business owners using Independent Contractors must supply each with a Federal 1099 
  Miscellaneous Form (supplemental income) 

Enclosed is a Business Registration form which is to be completed and returned to us.  Also enclosed 
is an Employee Withholding Tax Form (W-1) to report the Lorain employees' local income tax. 

To avoid any penalties and interest, all returns must be filed when due. Failure to comply with the above is in 
direct violation of the City of Lorain Income Tax Ordinance #152-94, which is punishable by fine and/or 
imprisonment. 

If you have questions or need assistance in this matter, call or stop by this office Monday through 
Friday, 8:30am to 4:00pm. 

Thank you for your cooperation in this matter. 

LORAIN DEPARTMENT OF TAXATION 

[[Auditor Inits]] 

 The information contained in this message is privileged, confidential, and intended for the sole use of the addressee. If you are not the intended recipient or the 
agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication or its 
contents is strictly prohibited. If you have received this communication in error, please notify the person listed above immediately and delete the original message 
and attachments. 

Data Privacy: For your protection, please remember to mask sensitive data, such as account numbers and tax identification numbers 
on all emails (e.g. for TIN XX-XXX1234, for account XXXXX5789) 

                         Income Tax office hours:  Lobby/Payments/Personal Service:  M-F 8:30am to 4:00pm 

                                Office/Phone Calls:  M-F 8:30am to 4:30pm   

                                         CITY OF LORAIN INCOME TAX DEPARTMENT 
                        605 WEST 4 THSTREET, LORAIN OH 44052 INCOMETAX@CITYOFLORAIN.ORG 

                             PHONE (440) 204-1002  RESIDENTFAX/ NON-RESIDENT(440) 204-1006  BUSINESS REGISTRATION   
                                                   Lorain City Income Tax Rate 2.5% 

Company Name:___________________________________                      SSN or Fed ID#___________________________ 
DBA or 
Trade Name:______________________________________                     Date Started or Acquired 
                                                                       in Lorain:_______________________________ 

Lorain Address:____________________________________                   Lorain Phone:___________________________ 

                    ____________________________________              Lorain Fax:______________________________ 

E-mail Address:____________________________________ 

Address of Main Office:_____________________________                  Phone: (          )___________________________ 

E-mail Address For_________________________________                   Accounting Period Used: 
Net Profit Accounts:                                                  Calendar Year_________      FYE Month______ 

E-mail Address For_________________________________                   Number of Persons Employed in Lorain:______ 
Withholding Accounts: 

OR:                             Payroll Service (no forms will be sent) 

Type of Ownership:              Corporation           Partnership           1120S          Individual           Non-Profit 

                         Other:___________________________________________________________ 

Complete The Following Information For All Partners, Officers And/or Associates: 

       Name:  ____________________________________________                                  SSN#:  __________________________ 
       Address:  __________________________________________   

       Name:  ____________________________________________                                  SSN#:     _________________________ 
       Address:   __________________________________________ 

If The Lorain Location Is Rented Or Leased, Please Provide Name, Address & Phone Of Rental Owner: 

Name:  ___________________________________________________                                  Phone:  __________________________ 

Address:   _________________________________________________ 

           _________________________________________________ 

_______________________________________                   _________________________________                        _____________ 
Signature                                                 Print Name                                               Date 

 **ALL INFORMATION ON THIS FORM IS CONFIDENTIAL AND IS USED FOR CITY INCOME TAX PURPOSES ONLY** 

Sub-contractor Name/Address 
                                                        $ 
                            Contact Name              Contract Amount 
                                                      
                            Phone Number               Estimated Start Date 
                                                      
                            EIN or Social Security #   Trade 
                                                      
Sub-contractor Name/Address 
                                                        $ 
                            Contact Name              Contract Amount 
                                                      
                            Phone Number               Estimated Start Date 
                                                      
                            EIN or Social Security #   Trade 
                                                      
Sub-contractor Name/Address 
                                                        $ 
                            Contact Name              Contract Amount 
                                                      
                            Phone Number               Estimated Start Date 
                                                      
Sub-contractor Name/Address 
                                                        $ 
                            Contact Name              Contract Amount 
                                                      
                            Phone Number               Estimated Start Date 
                                                      
                            EIN or Social Security #   Trade 
                                                      
Sub-contractor Name/Address 
                                                        $ 
                            Contact Name              Contract Amount 
                                                      
                            Phone Number               Estimated Start Date 
                                                      
                            EIN or Social Security #   Trade 
                                                            
  ***If more space is needed, you may attach a separate schedule that includes ALL of the required information listed above.