INDIVIDUAL QUESTIONNAIRE

The following information is required to properly establish your City of Englewood income tax account. Please answer questions fully and submit this questionnaire below. Englewood's Tax Rate is 1.75%

TAXPAYER #1		TAXPAYER #2 (SPOUSE)
Name:		Name:
Address:		Address:
Home Phone:		Home Phone:
Daytime Phone:		Daytime Phone:
Date of Birth:		Date of Birth:
Email:		Email:
Date moved to Englewood:		Date moved to Englewood:
Do you?	Own Rent Lease
If rent or lease, name and address of landlord:
TYPE OF INCOME (Please check all that apply)		TYPE OF INCOME (Please check all that apply)
Employed - W2 Income		Employed - W2 Income
Employer:		Employer:
Employer Address:		Employer Address:
Is Local Tax being withheld?	Yes No	Is Local Tax being withheld?	Yes No
If yes, name of city:		If yes, name of city:
Self-employed - Schedule C:		Self-employed - Schedule C:
Business Name:		Business Name:
Type of Business:		Type of Business:
Date Business began in Englewood:		Date Business began in Englewood:
Do you have employees?	Yes No	Do you have employees?	Yes No
Federal ID#:		Federal ID#:
Rental Property - Schedule E:		Rental Property - Schedule E:
Address of Rental Property:		Address of Rental Property:
Date acquired/date first rented:		Date acquired/date first rented:
Other Income:		Other Income:
List Other Income:		List Other Income:
OTHER HOUSEHOLD MEMBERS OVER THE AGE OF 18
Name 1:		DOB:
Name 2:		DOB:
Name 3:		DOB:
SIGNATORY
Taxpayer Signature:		Spouse Signature:
Date:		Date:

 

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