No Fee Form A
Due Date: January 31st
2
3. Financial Information
Accounting Period per Federal Return: ⃝ Calendar Year ⃝ Fiscal Year End Date:
Accounting Firm or Individual Name: Phone:
4. Mailing Information
General Mailing Name and Address:
Phone:
Fax:
Email:
Quarterly Occupational Tax Mailing (if different):
Phone:
Fax:
Email:
Net Profit License Fee Mailing (if different):
Phone:
Fax:
Email:
5. Statement of Responsibility
I, the undersigned, being the president, vice president, secretary, treasurer of any other person holding in an equivalent position
of this business entity subject to Ordinance 2008-05 understand that I shall be personally and individually liable, both jointly and
severally, for any tax required to be withheld from compensation paid to one or more employees of this business entity, and
neither the corporate dissolution or withdrawal of the business entity from the City, nor the cessation of holding any corporate
office, shall discharge the liability of any person; provided that the personal and individual liability shall apply to each or every
person holding the corporate office at the time the tax becomes or became obligated. I further understand that no person shall
be personally and individually liable under this subsection who had no authority to collect, truthfully account for, or pay over any
tax imposed by Ordinance 2008-05 at the time the taxes imposed by this ordinance become or became due.
6. Signature of Responsible Party:
Full Legal Name (Print): Phone:
Email:
Any business contracted by the City of Morgantown must have Liability Insurance and Worker’s Compensation
with the City of Morgantown added as additionally insured.
