CITY OF CINCINNATI
INCOME TAX DIVISION
NEW ACCOUNT APPLICATION
COMPANY NAME:
DBA:
STREET ADDRESS:
CITY/STATE/ZIP CODE:
PHONE NO: FAX NO:
SOC. SEC. NO: FED. ID NO:
CONTACT PERSON:
CINCINNATI LOCATION:
(If different from Company Address)
STREET ADDRESS:
CITY/STATE/ZIP CODE:
LOCAL PHONE NUMBER:
EMAIL ADDRESS:
LOCAL CONTACT PERSON:
TYPE OF BUSINESS ENTITY (Check the box that applies to your business):
CORPORATION
S-CORPORATION
PARTNERSHIP
SOLE PROPRIETORSHIP
LLC
SINGLE MEMBER LLC
JOINT VENTURE
TRUST
VOLUNTARY WITHHOLDER
NON-PROFIT
OTHER
(Specify)
NATURE OF BUSINESS: FISCAL YEAR END (Jan through Dec):
WILL YOUR COMPANY CONDUCT BUSINESS WITHIN CINCINNATI?
YES
NO
DATE BUSINESS ACTIVITY BEGAN IN CINCINNATI:
WILL YOU HAVE EMPLOYEES SUBJECT TO CINCINNATI WITHHOLDING TAX?
YES
NO
DATE WITHHOLDING ACTIVITY BEGAN IN CINCINNATI:
CORPORATION:
NAME RESIDENTIAL ADDRESS SOC. SEC NO:
PRESIDENT:
TREASURER:
PARTNERSHIPS (attach additional sheets if necessary):
PARTNER'S NAME RESIDENTIAL ADDRESS SOC. SEC NO:
SOLE PROPRIETORSHIP (including Single Member LLC):
OWNER’S NAME RESIDENTIAL ADDRESS SOC. SEC NO:
Website: www.cincinnati-oh.gov/citytax
Phone: (513) 352-2546 Fax: (513) 352-2542
Cincinnati, OH 45202-5799
805 Central Avenue Suite 600
Cincinnati Income Tax Division
Complete this form and send to:
PAYROLL COMPANY CONTACT AND PHONE NUMBER:
NAME OF PAYROLL COMPANY THAT YOU USE (if applicable):
QUARTERLY WITHHOLDING
< $2,400 PER YEAR
MONTHLY WITHHOLDING $2,400 - $11,999 PER YEAR
SEMI-MONTHLY WITHHOLDING > $12,000 PER YEAR
