CITY OF READING BUSINESS / PROFESSIONAL REGISTRATION FORM 
                       City of Reading · Income Tax Office · 1000 Market Street · Reading, OH 45215-3283 
                                   Phone: (513) 733-0300 · FAX (513) 842-1016 · www.readingohio.org 

                                                                                                                     Account #: __________ 
  ALL INFORMATION PROVIDED WILL REMAIN CONFIDENTIAL.  RETURN COMPLETED FORM IN ENCLOSED ENVELOPE WITHIN 15 DAYS 
 Name of Business           ______________________________________              Federal ID # / SS#                  ________________________________ 
 Corporate Address          ______________________________________              Corporate Phone #                    _______________________________ 
                            ______________________________________              Corporate Contact Person   ________________________________ 
 Doing Business As          ______________________________________              E-Mail Address                      ________________________________ 
 Reading  Address           _________________________Suite #_______             Reading Phone #                     ________________________________ 
 Nature of Business         ______________________________________              Reading Contact Person              ________________________________ 

 Starting date of Reading Operation:  ____________________________              Accounting Period                    Calendar   
                                                                                                                     Fiscal Year Ending ____ / ____ 
 Type of Business: (please check one)   
  Sole Proprietorship       Partnership        S Corporation      Corporation      Ltd Liability Co             Non-Profit 
 Names of Corporate Officers (If applicable):                            Number of employees at Reading Location: 
 President                  __________________________________                        Reported on W-2s:                  __________________________ 
 Treasurer                  __________________________________           Number of contractual employee’s at Reading location: 
 Partners (If applicable):                                                            Reported on 1099’s:                __________________________ 
          Name                             Address       
                                                                         Do you use a payroll company to submit monthly or quarterly 
 ___________________________               _________________________ 
                                                                         withholding payments?  (Please check one)     Yes    No               
 ___________________________               _________________________ 
                                                                         If yes, list payroll company:                   __________________________ 
                                                                          
 Resident Businesses   (businesses located in Reading): Do you own the property where business is located? (Please check one)         Yes    No     
 If No, Please complete property owner information:  Lessor Name:___________________________________________________________ 
 Address of lessor: ____________________________________________________________________________________________________ 
 Non-Resident Businesses (contractors, vendors, etc, temporarily conducting business in Reading): 
 Address of Reading job site: _______________________________________________________________________________________________ 
                                           Please attach a complete listing with addresses and phone numbers of all subcontractors    . 
  
I do hereby certify that to the best of my knowledge the above information is true, correct and complete.  Additionally, I understand that all 
information contained herein is confidential. 

_____________________________________________________________________________  _____________________ 
Signature                                               Title                                                            Date