BUSINESS REGISTRATION FORM
Income Tax Rate: 1.85%
In order to establish a new account with the City of Delaware Income Tax Department, or to update the current information on your account, please
complete this form. The information provided is confidential and will not be released.
FEIN (or SSN if Sole Proprietor):_________________________
Phone:________________________ Fax:_______________________
Principle Business Activity:_______________________________
Business Name:_______________________________________________
Mailing Address:______________________________________________________
Delaware Location Address:_________________________________________________________________________________________________
Contact Person Name:______________________________________
Email address:_______________________________________________
Name of Payroll Company, if applicable:__________________________________________________________________________________
Name of employee leasing company used, if applicable:___________________________________
FEIN:_____________________
COMPLETE SECTION A OR SECTION B:
A This company/individual DOES NOT conduct business in the City of Delaware. Tax withheld is paid on
behalf of employees who LIVE in Delaware (courtesy withholding). Date withholding begins:______________________
Provide employee name(s) and address(es):
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
B B This company/individual conducts business in the City of Delaware. Start date:___________________________
Delaware worksite address(es):____________________________________________________________________________________________
And withholds tax for employees working in Delaware as of: Date _____________________________________________________
Calendar year or
fiscal year? If fiscal, provide year end date:__________________________________________
If yes, you must attach a
Do you pay independent or sub contractors for service performed in Delaware?
listing to include name, address and SSN/FEIN.
Regarding real estate located within the City, do you occupy real property that you rent from others? If
If yes, to whom is rent paid? Name and address:
_______________________________________________________________________________________________________________________________
Do you own rental property in Delaware? If yes, attach a list of properties owned.
Do you use an individual or company to manage your rental property? If yes, provide their name, address and
SSN or FEIN: _______________________________________________________________________________________________________
If this account should be deactivated, give effective date (M/D/Y):_________________ and full explanation.
Type of Ownership (check all that apply):
Sole Proprietorship Limited Liability Co
Legal Partnership
Corporation Sub-
Chapter S Election
1 S SANDUSKY ST
/ P.O. BOX 496
DELAWARE, OH 43015
740-203-1225 / FAX: 740-203-1249
WWW.DELAWAREOHIO.NET
INCOMETAX@DELAWAREOHIO.NET
City, State, Zip:____________________________________
