SPENCERVILLE VILLAGE INCOME TAX DEPT.
P O BOX 57
SPENCERVILLE, OH 45887
419-647-4171
BUSINESS REGISTRATION
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 and Physical Address of Business
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Address to which tax forms are to be mailed
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Type of Ownership: ___ Proprietorship ___Corporation ___Partnership ___ Non-Profit
Other________________________________________________________
FEIN: _______________________________________________________________________
Nature of business conducted
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Accounting Period used for Federal Income Tax Purposes_______________________________
How many persons do you employee?_______________________________________________
Do you at any time during the year employ persons who are subject to the Village of Spencerville Income Tax and from whom you will not withhold the Income Tax? If so, please list names and addresses of such employees. (Note: If business is located within the Village corporation there are mandatory employee withholding requirements per Village ordinance.)
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Does business occupy, as tenant, real property (land/buildings) located within the Village of Spencerville rented from another party? ___________________________________________
If so, to whom is rent paid?______________________________________________________
If place of business is outside of the Village of Spencerville do you have earnings resulting from activity inside of Spencerville corporation limits?_____________________________________
Other - Supplementary Information
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Signature of Preparer ________________________________Title_________________________
Company_________________________________________ Date_________________________
Telephone________________________________________ Fax__________________________
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