CITY OF KETTERING • INCOME TAX DIVISION 
         P.O. Box 293100 • Kettering, OH 45429                            BUSINESS INCOME TAX   
    Phone: 937.296.2502 • Fax: 937.296.3242                                        REGISTRATION 
         email: ketteringtax@ketteringoh.org                                                       
         website: www.ketteringoh.org                                              Due Date:                          
                                                                                                   
Kettering Account Number:                                         

Please complete this income tax questionnaire and return it to our office by the due date stated above.    You may mail or fax your completed 
questionnaire to our office. Forms and additional information may be obtained by visiting our website.     

1.  Type of Organization:     _____ Partnership     _____ Corporation     _____ S-Corporation     _____ Nonprofit      _____ LLC   
   Which Federal Form Do You File:   _____ Form 1120          _____ Form 1120S         _____ Form 1065      _____     Federal Schedule C 

2. Business Name                                                                                                                           

   Federal ID #                                          or Social Security # (If Self Employed)                                           
3.  Nature of Business or Trade                                                            Telephone                                       

4.  Local Business Address                                                                                                                 

5.  Mailing Address (If different from above address)                                                                                      

6.  Email Address                                                                                                                          

7    Date activity started in City of Kettering _____/_____/______      Date activity terminated in City of Kettering _____/_____/_____   
   Accounting Period:    Calendar Year ___________      or Fiscal Year Ending _____/_____/______ 

8.  Do you have employees working in the City of Kettering? _____ No _____ Yes 
   If yes, when did your employee(s) start working in the City of Kettering? _____/_____/______ 
   If no, will you have employees working in the City of Kettering in the future? _____ No _____ Yes   
   Date employees will begin working in the City of Kettering _____/_____/______ 
9.  Approximate number of employees subject to City of Kettering Income Tax:                                                               

10.  Are you withholding only as a courtesy to employees who reside in the City of Kettering?   _____ No _____ Yes   
   If yes, what date did you first start withholding City of Kettering tax? _____/_____/______ 

11.  Are  you  using  a  payroll  company?  _____No  _____  Yes;    If  yes,  please  provide  your  payroll  processor: 
   _____________________________________________________________________________________________________________ 

12.  Do you use Subcontractors? _____ No _____ Yes 
   Please note:    All taxpayers who report payments to individuals (who are not employees) on Form 1099-Misc. for services 
   performed shall also report payments to the City when the services were performed in Kettering or when the payments are   
   made to a Kettering resident.     
13.  Does your business include any rental activity? _____ No _____ Yes   
   If yes, please list property addresses and date acquired (on back or separate attachment).   
14.  If you are a Partnership, S-Corporation or other unincorporated joint venture, list names, addresses and social security or 
   federal I.D. numbers of all partners, associates, or members in venture (attach additional sheets if necessary). 
                                                                                                                                           
15.  If you have filed City of Kettering income tax returns in prior years, please provide name and address used and year(s) filed: 
                                                                                                                                           
16. If there has been a change of ownership, please give name and address of former owner:                                                 

Print Name:                                                    Signature:                                                                  

Title:                                     Phone                                           Date _____/_____/______