City of Dublin Business Registration
The information requested on this form is essential to the establishment of your account and will be held in strictest confidence. Please
complete and return it to the City of Dublin Taxation, P.O. Box 9062, Dublin OH 43017-0962 within 10 days. If you have any questions,
please contact the City of Dublin Taxation at 614-410-4431. If you would prefer to fax the form do so at 614-448-9454. The form can also be
emailed to taxinfo@dublin.oh.us.
NET PROFIT
Type of Organization (Please check one) Date ______________________________
Corporation S-Corporation Partnership Non-Profit Sole Proprietor Other (Please explain)___________________________
COMPANY NAME______________________________________________________EIN # ___________________________________________
(DUBLIN ACCOUNT NUMBER)
DBA ___________________________________________________________________________________________________________________
Street Address __________________________________________________ City ______________________ State ______ Zip ____________
Phone Number ___________________________ Fax _______________________ Email ___________________________________________
NAICS Code ______________ (1120 Schedule K line 2A; 1120S Box B; 1065 Box C) Type of Business _______________________________
If a Limited Liability Company (LLC) will the Partnership or Partners file? ______________________________________________________
The company will be filing a consolidated return as ______________________________________________ EIN # ______________________
List Corporate Officers and/or Owners name and Social Security Numbers: (Attach an additional list if necessary)
Name ___________________________________________________________________________ SSN _________________________________
Street Address ___________________________________________ City ___________________ State ________ Zip ____________________
LOCATION OF BUSINESS IN THE CITY OF DUBLIN (Mandatory) :
Street Address __________________________________________________________ City ___________ State _____ Zip ______________
Local Phone # ______________________ Local Fax # ______________________ Email ___________________________________________
Date Operations began in Dublin _____________________________________ Number of Employees _______________________________
SOLE PROPRIETOR
If you are a Sole Proprietor and also do not have employees, please complete the following only. If you have employees complete the
withholding portion of this form.
NAME _______________________________________________________________________________ SSN# ___________________________
Street Address ______________________________________________ City ____________________ State: _______ Zip: ________________
Phone Number _______________________ Fax ______________________ Email ______________________________
WITHHOLDING:
PLEASE CHECK THE APPROPRIATE BOX: EIN # ______________________________
(DUBLIN ACCOUNT NUMBER)
Employees work within the city limits of Dublin - the withholding rate is 2%.
Business performs no work in the City of Dublin. We will be withholding taxes from residents as a courtesy.
NO EMPLOYEES work in the City of Dublin.
Are you using a payroll service ? Yes No Name of Payroll Service: _______________________________________________________
Contact Name __________________________________________ Contact phone number___________________________________________
PLEASE INDICATE THE FREQUENCY OF WITHHOLDING:
Quarterly (under $200.00/month) Monthly (over $200.00/month) Semi-Monthly (over $1000.00/ month)
IF YOUR PAYROLL PROVIDER REQUIRES VERIFICATION OF YOUR DUBLIN ACCOUNT NUMBER, FAX THEM A COPY OF
THIS FORM TO VERIFY DUBLIN USES YOUR EIN AS OUR ACCOUNT NUMBER.
CONTACT PERSON FOR ACCOUNT: __________________________________________ Phone # ________________________________
ALL FORMS ARE AVAILABLE ON OUR WEB SITE: www.dublintax.com Dublin is not a pure zip code please call for verification of
address if you are not sure of the location.
