CITY OF IONIA           INCOME TAX DIVISION                                                           PH  616-523-0142 
114 KIDD ST             PO BOX 512            IONIA  MI  48846                                        FAX 616-527-0810 

          BUSINESS REGISTRATION AND EMPLOYER'S WITHHOLDING REGISTRATION 

Trade Name: 

Federal ID: 

Mailing Address: 

Owner(s): 

Ionia Address: 

Type of Organization:              Individual Owner            Nonprofit                                  Partnership 
                                   Corporation                 Other (Attach Explanation) 

Contact Person:                                                Phone: 
                 Please Print 
Date Business Acquired: 

Date First Paid Wages Subject to Withholding in Ionia: 

Was Business Previously Operated by Another Employer? 
If Yes, Give Name: 

Accounting Period:                 Calendar Year 
                                   Fiscal Year Ending: 

Please Check One: 

                 Resident Business 
                        Located inside Ionia City Limits and/or doing business or performing services inside Ionia 
                        City Limits.  A resident busines is REQUIRED by the Uniform City Income Tax Ordinance 
                        to withhold and remit City Income Tax on resident and nonresident employees and file a 
                        W-3 with W-2's by FEBRUARY 28 of each tax year.  Business is also responsible for 
                        filing a return with the City based on income earned inside Ionia City Limits. 

                 Nonresident Business 
                        A business withholding Ionia City Income tax for residents of the City of Ionia who work 
                        at a business located outside City Limits.  This business is requesting to be allowed to 
                        withhold from City of Ionia residents working at this business and agrees to remit quarterly 
                        withholding payments and year end W-3 with W-2's as is required by the Uniform City 
                        Income Tax Ordinance. 

                 Other  Providing services or conducting business inside City Limits on a short term basis. 
                        (Example:  Contractors, peddlers, fair venders, antique dealers, etc.)  Responsible for tax 
                        on income earned in Ionia and possible withholdings on employees.  Must at least report 
                        wages earned or employees working inside City Limits.  Must withhold per Uniform City 
                        Income Tax Ordinance. 
By signing this form, I declare that I understand all or my obligations to the City of Ionia for income tax and that I will abide by the 
requirements of the Uniform City Income Tax Ordinance and the City of Ionia Income Tax Department rules and regulations.  I also 
declare that the information provided here is to the best of my knowledge true, complete and correct. 

Signature                                     Title                                                       Date