B A R     C O D E     L A     B E        L INDIVIDUAL   QUESTIONNAIRE
                                               AKRON  INCOME TAX DIVISION 
This is the questionnaire for individual        1 Cascade Plaza - Suite 100
and joint filers.  If you are a business        Akron,  OH  44308 -1161
filer use the Business Questionnaire.         (330) 375-2290     Fax (330) 375-2112
                                                                  
              The following information is necessary to update your income tax records with the City of Akron.             
      PLEASE COMPLETE ALL LINES AND RETURN THIS QUESTIONNAIRE WITHIN TEN (10) DAYS.

                                                                           TAX  OFFICE  USE  ONLY 
                                                                  Date issued ______________________________ 
                                                                  Auditor__________________________________ 
                                                                  Account No. ______________________________ 
                                                                  Akron Dist ____________   IND Code__________

NAME  ____________________________________________________________________________    SOC  SEC  # __________________________

ADDRESS_________________________________________________________________________________________________________________
OCCUPATION _______________________________________________________________    DAYTIME  PHONE ____________________________ 
SPOUSE’S NAME____________________________________________________________________   SOC  SEC  # __________________________
If  you have filed a City of Akron Income Tax Return before, under what name and Akron tax account number did you file? 
NAME USED ________________________________________________________________________    Account  # ___________________________ 
If under the age of 25, what is your birth year? _______    (Akron resident’s 18 and older have a filing requirement, whether employed or not.)

List your employment history including SELF-EMPLOYMENT, UNEMPLOYMENT, SCHOOL, etc., for the past 6 years. 
 (If SELF-EMPLOYED write “SELF” below, along with “FROM” and “TO,” and complete the Business Questionnaire.) 

    DATES                                                                                                               WAS CITY               FOR 
                      EMPLOYER’S   NAME                          ADDRESS   WHERE  YOU   WORKED                          TAX                    WHICH 
                                                                                                                        WITHHELD?              CITY? 
 FROM     TO 

List all of your FORMER  ADDRESSES  and DATES OF RESIDENCY for the past 6 years.

 FROM     TO                     STREET                                                                 CITY                                   STATE

Do you own rental property in Akron?    YES _______    NO_______      (If yes,  we will send you a rental questionnaire upon receipt of this form.)
Under penalties of perjury,  I certify that all information and statements herein are true and correct. 

Signature __________________________________________________________   DATE _________________________  11/2006