CITY OF SHARONVILLE REGISTRATION FORM                                                             Print Form

                                  City of Sharonville • Income Tax Office • 11641 Chester Road • Sharonville, OH  45246-2803 
                                                Phone: (513) 563-1169 • FAX: (513) 588-3969 • www.sharonville.org
                                                                                                                                 Account #:

                    ALL INFORMATION PROVIDED WILL REMAIN CONFIDENTIAL.  RETURN COMPLETED FORM IN ENCLOSED ENVELOPE WITHIN 10 DAYS.
Resident Name                                                                                Birth Date                          SS#
Resident Name (Spouse)                                                                       Birth Date                          SS#
Sharonville Address                                                                          Apt          Phone #                               Listed Unlisted
Mailing Address                                                                              Move-In Date                        Move-Out Date
EMAIL Address
                                              EMPLOYMENT INFORMATION (Attach current pay stub and/or copy of W-2)
                                                RESIDENT                                                            RESIDENT (SPOUSE)
Name of Employer      
Employment Location    

Employment Date  
Occupation
List all cities for which taxes are withheld
          LIST BELOW ALL OTHER OCCUPANTS OF HOUSEHOLD REGARDLESS OF EMPLOYMENT STATUS.  USE ADDITIONAL PAPER IF NECESSARY. 
If anyone listed below pays City taxes through their employer, a copy of a recent pay stub or W-2 should be included with this registration form.
                                                                                                                                    EMPLOYMENT  CITY EARNINGS 
                NAME                        DOB     SS#                             EMPLOYER            EMPLOYER ADDRESS
                                                                                                                                           DATE TAX PAID TO

If you purchased the home, give name of Sales Agent                                                     and Listing Agent
If you rent, give name and address of landlord
If you or any member of your family owns rental property, please list the following:

Name of owner of rental property:                                                                              Date acquired for rental:
Address of rental property:                                                                  Name of current tenant:
                                                                                             (if property located in Sharonville)
I do hereby certify that to the best of my knowledge the above information is true, correct and complete.

                                  Signature                                                               Date                                  Form RF-I REV 09/13