City of Springfield
Division of Taxation
NP Acct # _____________________
P. O. Box 5200
Springfield, Ohio 45501 WH Acct # ____________________
Phone: (937) 324-7357 (office use only)
Fax: (937) 328-3471
www.springfieldohio.gov
email - tax@springfieldohio.gov
BUSINESS - INCOME TAX QUESTIONNAIRE
The following information is required to properly establish your City of Springfield income tax account.
Please answer all questions fully and return this form to the address above.
(PLEASE TYPE OR PRINT)
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1. Type of Organization: Partnership Corporation S Corporation Sole Proprietor
(Please check one) Nonprofit Organization Other (Explain):
2. Business Name Federal ID No.
3. Type of Business or Trade
4. Springfield Business Address Local phone ( )
5. Mailing Address ________________________________________________________Corp phone ( )
City, State, Zip code _________________________________________________________________________________
6. Email Address FAX ()
7. Full Name ofOwner Social Security No.
8. Owner Home Address (if sole proprietor) Telephone ( )
9. Date activity started in City ofSpringfield, / / Accounting Period: Calendar Year
or Fiscal Year Ending / /
10. Do you own rental properties within the City of Springfield? No Yes If yes, please list
property addresses and date acquired (on back or separate attachment).
11. Do you have employees working in the City ofSpringfield? No Yes If yes, what date did your
Employee(s) start working in Springfield? / / _
12. Local Worksite/job location: ____________________________________________________________________
13. Are you withholding only as a courtesy to employees who reside in the City of Springfield ? No Yes
If yes, what date did you first start withholding City ofSpringfield tax? / /
14. Withholding frequency? Q M SM . As of 1/1/16, if your withholding remittance is more
than $200 per month, you must remit monthly; if more than $1000 per month, you must remit semi-monthly.
15. Do you utilize a payroll company? No Yes . Ifyes, payroll company name
16. Do you use Subcontractors? No Yes . If you are using Subcontractors, for any portion of your business, please
indicate the name, address, and Federal ID number(s)/Social Security Number(s) of the company(ies) or individual(s) who
contracted with you for work performed in Springfield. (on back or separate attachment).
17. If you have filed City income tax returns before, show name and address used and which year(s) were filed.
18. If this is a change of ownership, give name, address, and telephone number of former owner:
Date of change / /
Print Name: Signature: Title:
Date / / (Rev 4/19)