COMPLETE THIS FORM AND SEND TO: 
              CITY OF KETTERING                                                                               City of Kettering Income Tax Division 
    BUSINESS INCOME TAX REGISTRATION                            P.O. Box 293100 – Kettering, OH 45429 
    Kettering Acct. #:  ___________                             Phone (937) 296-2502  Fax: (937) 296-3242 
                                                                                                              E-mail: Ketteringtax@ketteringoh.org 
    Due Date:  _____________                                                                                  Website: www.ketteringoh.org 
 
Type of Business Entity (Please check one) 
 ___ Corporation (1120)   ___ S-Corporation (1120S) ___  Partnership (1065)                                           ___  Sole Proprietor Sch. C 
 ___ Non-Profit 990       ___ Trust (1041)          ___  Domestic Help                                                ___  Other (specify) 
Which Federal Form Do You File:  _____ 1120     _____ 1120S     _____ 1065     _____ Federal Schedule C     _____ 1041 
 
Company Name: __________________________________________________  Federal EIN#: _____________________ 
Mailing Address: ________________________________________   City: ________________ State: ______ Zip: ______ 
Business Address in Kettering: ________________________________________________________________________ 
Phone #: __________________________  Email Address: __________________________________________________ 
Nature of Business: ____________________________________ Calendar Yr. ____ or Fiscal Yr. Ending on ___/___/___ 
Tax/Payroll Contact Person(s): _________________________________________  Phone #: ______________________ 
Business activity began in City of Kettering: ____/____/____ Activity terminated in City of Kettering: ____/____/____ 
                         
PLEASE CHECK THE APPROPRIATE BOX: 
  Employees work within the city limits of Kettering. (Withholding rate is 2.25%) 
  Business performs no work in the City of Kettering. We will be withholding taxes from residents as a courtesy. 
  NO EMPLOYEES work in the City of Kettering. 
  Subcontractors are used. [All taxpayers who report payment to individuals (who are not employees) on 
   Form(s) 1099-MISC or 1099-NEC must remit copies to the City when the services were performed in Kettering 
   or payments made to a Kettering resident.] 
 
REMOTE EMPLOYEES: Effective January 1, 2022, employers are required to withhold municipal income tax where an 
employee’s work is actually performed, for each portion of a day worked in any taxing municipality where the 
employee performs services for the employer. 
 
Are you using a Payroll Service/Employee Leasing Co.: ___ Yes ___ No       Service/Co. Name: _____________________ 
Authorized Contact: ___________________________________________  Phone #: _____________________________ 
 
PLEASE PROVIDE YOUR PAYROLL SERVICE WITH THE ASSIGNED KETTERING ACCOUNT NUMBER. 
 
REMITTANCE: ____ Quarterly (under $200.00/mo.)    ____ Monthly (over $200.00/mo.)                                      
 
CORPORATE OFFICERS OR PARTNERS:  (If more than one attach list) 
 
Name: _________________________________________  Title: _____________________________________________ 
 
SOLE PROPRIETORSHIP (including Single Member LLC): 
Owner’s Name                                                                             Residential Address                            Soc. Sec. # 
 
_______________________________    ______________________________________________   _________________ 
 
If change of ownership, provide date of change, name, address and phone # of former owner: 
_________________________________________________________________________________________________ 
 
PRINT NAME: __________________________________   SIGNATURE: _______________________________________ 
 
TITLE: _____________________________________ PHONE #: ___________________________ DATE: _____________