OCCUPATIONAL TAX APPLICATION
1) NAME AND TYPE
NAME
INDIVIDUAL, PARTNERSHIP, CORPORATION, or OTHER?
INDIVIDUAL
PARTNERSHIP (LIST NAME & ADDRESS OF EACH PARTNER ON LINE 8)
CORPORATION
OTHER
IF CORPORATION - DATE ORGANIZED
/
Month
/
Day
Year
Date
IF CORPORATION - STATE
IF OTHER - PLEASE SPECIFY
2) TRADE NAME
TRADE NAME (if different from above)
3) ADDRESSES (please complete for all applicable addresses. Indicate zip code & telephone number)
A. PRINCIPAL BUSINESS LOCATION:
TELEPHONE:
B. LOCATION IN ST MATTHEWS (if different from above)
TELEPHONE:
C. RESIDENCE (if individual proprietorship, or self-employed person):
TELEPHONE:
D. MAILING ADDRESS
TELEPHONE
E. IF CORPORATION, NAME AND ADDRESS OF AGENT FOR SERVICE OF PROCESS IN KY:
TELEPHONE
4) FEDERAL TAX ID NUMBER
FEDERAL TAX IDENTIFICATION NUMBER
A. IF INDIVIDUAL PROVIDE SOCIAL SECURITY NUMBER
5) NATURE OF BUSINESS
5) Please describe your business and its operation, including where and how sales, services, or other activities that take place. Any other pertinent information
6) APPROXIMATE NUMBER OF EMPLOYEES WORKING IN ST. MATTHEWS:
FULL TIME
PART-TIME:
SEASONAL
CONTRACT OR LEASED
CONTACT INFORMATION FOR PAYROLL PROCESSING
7) IF BUSINESS WAS OBTAINED FROM A PREVIOUS OWNER, OR CHANGE IN THE TYPE OF ORGANIZATION:
A. GIVE DATE OF AQUISITION OR CHANGE:
B. GIVE NAME OF PREVIOUS OWNER OR ORGANIZATION:
C. GIVE FORMER TRADE NAME, IF ANY:
8) OTHER INFORMATION
8 OTHER INFORMATION (attach more if necessary)
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9) I HEREBY CERTIFY THAT ALL INFORMATION AND STATMENTS ARE HEREIN TRUE AND CORRECT
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