Employer'S Quarterly Return Of License Fee Withheld Template - Mccracken County Tax Administrator

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MCCRACKEN COUNTY TAX ADMINISTRATOR
EMPLOYER'S QUARTERLY RETURN OF LICENSE FEE WITHHELD
If no wages were paid this period, mark "NONE" and return this form
1.
Total earnings paid all employees in quarter within
$ _______________
_______________
Number of Taxable Employees
McCracken County.
$ _______________
2.
Less earnings for work or services rendered in City of
Paducah only.
I hereby certify that the information, schedules, statements and exhibits filed
$ _______________
3.
Taxable Balance - Line 1 Less Line 2
herewith are true and correct.
$ _______________
4.
TAX DUE AT:
1.00%
Signed _____________________________________________________
$ _______________
5.
5.00%
Penalty per calendar month
(not less than $25.00)
6.
Interest (per month)
1.00%
$ _______________
OfficialTitle ________________________________ Date ___________
BALANCE DUE
7.
$ _______________
FOR PERIOD ENDING
Make check payable and
mail to:
Account No.
Month
Day
Year
MCCRACKEN COUNTY TAX
ADMINISTRATOR
RETURN DUE ON OR BEFORE
P O BOX 2658
PADUCAH KY 42002-2658
Month
Day
Year
Phone:
(270) 444-4722
Fax:
(270) 444-4737
Indicate any name or address change above.
FED ID No.
*PLEASE MAKE A COPY OF THIS FORM FOR YOUR RECORDS.
Form OCC-3PT Rev. 1/22/2010
Print Form

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