City of Green 
                             Division of Taxation 
                                 PO BOX 460 
                            GREEN OH  44232-0460 
 PHONE: 330 896-6622                                   FAX 330 896-6927 
 Email: taxsecure@cityofgreen.org                Website: www.cityofgreen.org/income-tax 
                                                          
          INDIVIDUAL REGISTRATION FORM 
           MUNICIPAL INCOME TAX 
                                                
  PLEASE RETURN THIS REGISTRATION TO THE ADDRESS ABOVE  
 
SOCIAL SECURITY NO. ________________ SPOUSE  S.S. NO. _____________________ 
HEAD OF HOUSEHOLD_________________________ PHONE NO. _________________ 
SPOUSE ___________________________________________________________________ 
STREET ADDRESS__________________________________________________________ 
CITY_____________________________STATE______________ ZIP__________________ 
DATE MOVED INTO GREEN_________________________________________________ 
 
EMPLOYMENT (GIVE NAME AND ADDRESS OF EMPLOYERS) INDICATE WHETHER 
FOR YOURSELF OR SPOUSE 
 
 NAME                                   ADDRESS/CITY                    CHECK ONE 
 
__________________________    ____________________         SELF___ SPOUSE ___ 
__________________________    ____________________         SELF___ SPOUSE ___ 
__________________________    ____________________         SELF___ SPOUSE___ 
__________________________    ____________________         SELF___ SPOUSE___ 
 
CHECK OTHER SOURCES OF INCOME: RENT__ PENSION__ SELF EMPLOYED___ 
 
TRADE NAME AND ADDRESS IF SELF EMPLOYED___________________________ 
OTHER (PLEASE SPECIFY) _________________________________________________ 
 
LIST ALL OTHER RESIDENTS IN HOUSEHOLD (AGE 18 OR OVER) 
 
 NAME                                     AGE             SOCIAL SECURITY NO 
 
___________________________       _____        ________________________________ 
___________________________  _____        ________________________________ 
___________________________       _____        ________________________________ 
___________________________       _____        ________________________________ 
___________________________  _____        ________________________________ 
 
SIGNATURE_____________________________ DATE___________________________ 
                                                                                    

         CITY OF GREEN MUNICIPAL INCOME TAX 
 
The municipal income tax is required to be filed and paid by:  all residents and part year 
residents age eighteen or older at the end of the year; all non-residents receiving compensation 
for work done or services performed in the City whose employer did not fully withhold Green 
Income Tax; non-residents owning rental property in the City; real estate agents earning 
commission on the sale or rental of property located in Green; insurance agents who work for a 
broker located in the City; businesses, contractors, and subcontractors located or doing business 
in the City.  A credit of up to two percent (2%) will be allowed for taxes paid by residents of 
Green to another municipality.  The tax also applies to net profits of corporations, partnerships, 
and businesses located or doing business in the City of Green. 
 
Examples of taxable income include, but are not limited to:  earned income (salaries, wages, 
commissions including wage continuation plans for sick pay, vacations, deferred compensation, 
etc.)  tips, distributive share of net profits of a partnership, LLC, or  subchapter "S"  corporation, 
net profits from a business, net rental income, oil & gas royalties, and income from lotteries, 
sweepstakes, gambling, games of chance, prizes and awards. 
 
Examples of exempt income include, but are not limited to:  pensions or annuities paid under a 
retirement plan, intangible income, capital gains on investments and other unearned income 
including alimony and child support, proceeds from insurance, welfare, unemployment benefit 
payments paid by the State of Ohio, military pay and allowances for duty with the armed forces. 
 
                                      REGISTRATION 
 
All residents receiving this notice are requested to complete the enclosed registration and return 
it to the Income Tax Office within ten (10) days.  
 
                                      INFORMATION 
 
The Income Tax Office is located in the Central Administration Building at 1755 Town Park 
Boulevard.  The telephone number for the tax office is (330) 896-6622.  U.S. mail is not 
delivered to this physical location.  The mailing address is as follows: 
                                      City of Green  
                                      Division of Taxation 
                                          PO BOX 460 
                                GREEN OH  44232-0460 
                                           
Email: taxsecure@cityofgreen.org                Web site: www.cityofgreen.org/income-tax 
                                           
         INDIVIDUAL FILING REQUIREMENTS 
                                           
         th
An annual return is due April 15  or on the due date of the Ohio individual income tax return, 
whichever is later. An annual estimate is required to be filed by April 15th of each year if the 
amount of non-withheld tax expected to be due will exceed $200.00.  
 
Rev 2/17