FOR THE PURPOSE OF OUR RECORDS WITH REGARD TO FOSTORIA CITY INCOME TAX,

PLEASE COMPLETE AND RETURN THIS QUESTIONNAIRE PROMPTLY IN THE ENCLOSED

SELF-ADDRESSED ENVELOPE. THANK YOU FOR YOUR HELP.

Local name and address as used for business purposes:

TRADE NAME _______________________________________________________________

LOCATION __________________________________________________________________

Federal Identification Number or Social Security Number__________________________________

Nature of Business Conducted ________________________________________________________

Accounting Period for Federal Income Tax Purposes

__________Calendar Year __________Fiscal Year ________________Period Ending

Do you or will you have any employees working within the city limits of Fostoria? _______________

(IF THE ANSWER IS YES, YOU ARE REQUIRED TO WITHHOLD TWO PERCENT (2%)

OF THEIR GROSS WAGES FOR FOSTORIA CITY INCOME TAX. THIS APPLIES TO ALL

EMPLOYEES EIGHTEEN YEARS OF AGE AND OLDER.)

Type of Ownership __________________________________________________________________

Owner’s Name and Address (If partnership, attach list of names and addresses)

Name ____________________________________Address______________________________

City _____________________________________ State ____________________Zip_________

Do you operate any other businesses within the City of Fostoria? ___________________________

(If yes, please attach list of business names and addresses)

Does the business occupy property rented from others? ________ If so, to whom is the rent paid?

Name ____________________________________Address______________________________

City _____________________________________ State ____________________Zip_________

10. Address to which forms are to be mailed: ________________________________________________