I N C O M E   T AX   D E P AR T M E N T   
                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                          P.O. Box 862 | Findlay, OH 45839-0862 
                                                                                                                 Ph. 419-424-7133 | Fax: 419-424-7410 |  www.findlayohio.com  
 
                                                          Business-Employer Registration Form 
                                                                                Effective tax rate: 1.00%                                
 
  1.  Individual’s or business’ legal name ____________________________________________________________ 
 
  2.  Trade name or doing business as ______________________________________________________________ 
 
  3.  Mailing address ____________________________________________________________________________ 
                                                                 Street/PO Box                                                                                                                        City                                                                     ST                                Zip 
 
  4.  Findlay-area street address ___________________________________________________________________ 
 
       If a contractor, project or job site name __________________________________________________________ 
 
  5.  Phone  __________________________      Contact person  _________________________________________ 
 
  6.  Soc. Sec. #___________-________-______________              Fed. ID #_________-______________________ 
                                               Please provide this number for any single-member LLC owned by an individual                                                       The Federal identification number under which W-2s will be reported 
                                               Please provide this number if the income and expenses will be reported on a Schedule C                                       This number will be your employer withholding account number 
 
   7.  Structure:  Corporation ____         S Corporation ____         Partnership/LP/LLC/LLP ____         Non-profit ____ 
                         Sole Proprietor ____         Individual Single-member LLC ____         Government ____ 
 
  8.  If not a calendar year, the fiscal period is:  _______________________________________________________ 
 
  9.  If applicable, what is the name, owner, and Federal ID number of the previous business?  _________________ 
 
       _________________________________________________________________________________________ 
 
10.  If you answered question 9, what is the effective date of the change?   _____/_____/_____ 
 
11.  Will employees work in the Findlay city limits; or will you be withholding tax only from employees who live in 
       Findlay, but do not work in Findlay? 
 
           Yes, employees will work in Findlay ____          or          Employees live, but do not work in Findlay ____ 
            No, employees will not work in Findlay ____                   (Please list their names and SSNs on the back) 
 
12.  Date you will begin withholding  ______/______              Date you will stop withholding  ______/______ (if known) 
                                                                                                                Month               Year                                                                                                                                 Month               Year 
 
13.  Approximately how much tax will you remit per year?  $______________     If $2,400 or more, State law requires a monthly remittance. 
 
14.  If you use a payroll service provider, what is the provider’s name?  ____________________________________ 
 
15.  If applicable, will your payroll service provider be remitting monthly or quarterly?   Monthly ___       Quarterly ___ 
 
16.  If your physical address in Findlay is a new facility, 
       provide the name and address of the contractor.  __________________________________________________ 
 
17.  If you are renting your Findlay facility, please 
       provide the name and address of the property owner.  ______________________________________________ 
 
18.  What is the nature of your business’ activities? ____________________________________________________ 
 
19.  What is your IRS-required six-digit NAICS Principal Business Activity Code Number?  _____________________ 
 
            On the back, please list the names, residence addresses, and social security numbers of the corporate officers, partners, members, or S corporation shareholders.                                                                                                                                         
       _______________________________________________________ 
              Signature of person who furnished this information                                                                                  Date