SPENCERVILLE VILLAGE INCOME TAX DEPT.
P O BOX 57
SPENCERVILLE, OH 45887
INDIVIDUAL REGISTRATION FORM
The information provided on this form will remain confidential and be used strictly for the Village of Spencerville Income Tax files to assist in preparing forms for compliance of the Village Income Tax Ordinance. Please complete the form and return to our office within ten days of receipt. Thank you for your cooperation.
Name (Yourself and Spouse) and Address
Date you became residents of Spencerville:__________________________________________
Employer(s) Name and Address (Please list all employment)
Is Spencerville Village Income Tax Withheld by your employer?_________________________
If not currently employed please indicate status: Retired____ Disability____ Laid Off_____
Do you have rental or farm income? If so, where is rental property or farm located?
Do you pay municipal income tax to another town/city? If so please give name of municipality.
Other employed person(s) residing at this address. Please list their names(s) and place(s) of
Are you self-employed? __________ If so, do you have employees?_____________________
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