IT-47
Form
Business Type
City of Columbus, Income Tax Division
Request for Municipal Income Tax Account:
Rev. 9/2/2011
Columbus Collection Group
C-Corporation (1120)
Non-Profit
Partnership (1065)
S-Corporation (1120S)
Sole Proprietor
Trust (1041)
(Schedule C)
PART A
Zip Code
State
City
Mailing Address for Business Tax Returns and Correspondence
Taxpayer's Legal Name
Taxpayer Federal EIN/FID/SSN Reporting Agent's Federal EIN
Mailing Address for Payroll Tax Returns and Correspondence
Trade Name
Fiscal Year End (if applicable)
Name of Payroll Service or Employee Leasing Company( if any)
Payroll Service
Leasing Co.
Zip Code
State
City
Columbus (01)
Groveport (09)
Obetz (10)
Canal Win. (11)
None
Harrisburg (16)
Brice (14)
Marble Cliff (13)
Communities in our Collection Group in which you are or will be
conducting business
Date Business started in
our area
Date of 1st Payroll for
Columbus Collection Group
Approximate Monthly Payroll for Employees Working in our
Collection Group
Nature of Business (i.e.
computer, consulting etc.)
Pay cycle (i.e. weekly,
biweekly, monthly etc.)
CONTACT INFORMATION
Name of President, CEO, Tax Matters, Partner or Trustee
SSN of President, CEO, Tax Matters Partner, or Trustee
Zip Code
State
City
Home Address of President, CEO, Tax Matters, Partner or Trustee
Name of Internal Payroll Tax Contact
Payroll Tax Contacts Title
Payroll Tax Phone No.
Payroll Tax Fax No.
Business Tax Fax No.Business Tax Phone No.
Business Tax Contacts Title
Name of Internal Business Tax Contact
Zip Code
State
City
Home Address of President, CEO, Tax Matters, Partner or Trustee
SSN of Officer or Partner in Charge of Payroll
Name of Officer or Partner in Charge of Payroll
State
Zip Code
City
City
State
Zip Code
Street Address
List all Columbus area addresses where you have employees working. Consulting firms should include the addresses of client locations if the firm has employees physically working at
client sites (indicate if address given is a client site). Construction firms should include job site addresses (indicate if address given is a job site). Businesses with a significant number of
field employees who work at multiple customer sites in a week should list only their actual locations, and in one of the boxes below indicate the geographic area served by their field
employees (for example: “Field employees working out of our Columbus office serve our Ohio and Indiana customers”). Attach a separate sheet if more space is needed.
GREATER COLUMBUS METROPOLITAN AREA ADDRESSES
PART C
Street Address
CONTACT INFORMATION
SPECIAL INSTRUCTIONS FOR PARTNERSHIP AND S-CORPORATIONS
PART D
Attach a separate sheet showing the name, SSN/FID and address of each partner or shareholder. *Identify owner/member’s name, address, and FID No. (SSN
if an individual). If the owner is a corporation, include an officer and SSN. If a partnership, include the tax matters partner with SSN.
SIGNATURE OF PERSON COMPLETING FORM PART E
Date
GENERAL INFORMATION
PART B
Signature
