CITY OF WAPAKONETA 
                              INCOME TAX DEPARTMENT 
                             701 PARLETTE CT, P. O. BOX 269 
                             WAPAKONETA, OHIO 45895-0269 
                                           (419) 738-7342    
                                          (419) 738-4762   Fax 
 
                BUSINESS AND PROFESSIONAL QUESTIONNAIRE 
 
Please complete this questionnaire and return it to the Income Tax Department.  Information provided will be 
used exclusively for income tax purposes and will not be further disclosed. 
 
Name ______________________________________ dba _________________________________________ 
 
Address _____________________________________City/State/Zip_________________________________ 
 
Telephone # ___________________  Fax # ___________________  E-Mail ___________________________ 
 
Federal Employer ID or Social Security No. _____________________________________________________ 
 
Nature of business conducted: ________________________________________________________________ 
 
Accounting method (check one)  [  ] calendar year ending December 31  [  ] fiscal year ending _____________ 
 
Do you now employ one or more persons? _____    If yes, how many? _______    If no, will you? __________ 
 
Date that your business began operating within the City of Wapakoneta ________________________________ 
 
Type of ownership:   [  ] Proprietorship   [  ]  Partnership 
                [  ] S Corp                [  ]  Non-profit Corporation 
                [  ] C Corp                [  ] Other – Specify ______________________ 
 
If the business is located outside of the City of Wapakoneta, are you withholding income taxes as a courtesy for 
your employees? 
 
Address to which tax forms, notifications and official correspondence are to be mailed: 
 
Business Name________________________________________ Attention ____________________________ 
 
Address ______________________________________ City/State/Zip________________________________ 
 
Phone Number (_____) ______________________             Fax Number (______) _______________________ 
 
Signature of individual completing form and title __________________________________________________ 
 
Printed Name ___________________________________                                    Date _____________________ 
 
                                                               Acct No. ______________________