Employers Quarterly Return Of License Fee Form - City Of Florence, Kentucky
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CITY OF FLORENCE, KENTUCKY
EMPLOYERS QUARTERLY RETURN OF LICENSE FEE
(NOTE: This original must be filled out and returned to the City of Florence. Please make a copy for your personal records.)
CALENDAR YEAR
2008
QUARTER ENDING
DUE DATE
12/31
1/31
Business Name:
____________________________
Federal ID/SS #: ____________________________
Address:
____________________________
Phone #:
____________________________
Address:
____________________________
City/State/Zip:
____________________________
Check here for address changes.
INSTRUCTIONS: If this is a 1st, 2nd, 3rd or 4th Quarter return, please fill out section 1 below.
For the Annual Reconciliation, please fill out section 2 below.
SECTION 1. QUARTERLY RETURN FOR QUARTERS 1, 2, 3, and 4
Annual wage cap for taxable wages/compensation
Gross wages
$ _____________________
1
is equal to Social Security maximum.
Less wages earned outside city/over SS MAX
$ _____________________
2
This quarterly return must be remitted to the City of
Total City of Florence taxable wages
$ _____________________
3
Florence EVEN IF THERE ARE NO WAGES TO REPORT!
Non filers will be subject to penalty.
Total tax due (line 3 x 2%)
$ _____________________
4
Penalty
$ _____________________
(Minimum of $25 or 5% per month not to exceed 25%)
5
Florence Finance Department at (859) 647-5413.
Interest (1% per month)
$ _____________________
6
$ _____________________
Required
TOTAL:
Number of Employees: _________________________
For Quarter Ending (Circle One):
3/31
6/30
9/30
12/31
Due Date:
4/30
7/31
10/31
1/31
SECTION 2. ANNUAL RECONCILIATION and W-2/W-3 FORMS DUE 2/28
This annual
Payments Remitted
Gross wages (per W-2's)
$ _____________________
1
reconciliation
(excluding penalties & interest)
must be re-
Less wages earned outside city/over SS MAX
$ _____________________
2
mitted to the
1Q
$ ____________________
City of
Total City of Florence taxable wages
$ _____________________
3
Florence, even
2Q
$ ____________________
if there are NO
Total tax due (line 3 x 2%)
$ _____________________
4
wages to report.
3Q
$ ____________________
Less total already remitted (Sub-Total from left)
$ (____________________)
5
If you have any
4Q
$ ____________________
questions, please
$ _____________________
6
Sub-Total of Balance Due :
contact the City of Sub-
Penalty
Florence Finance Total $ ____________________
$ _____________________
(Minimum of $25 or 5% per month not to exceed 25%)
7
Department .
at (859) 647-5413
Interest (1% per month)
$ _____________________
8
$ _____________________
Balance Due:
Please make sure to include W-2 and W-3 forms with this remittance!
For returns WITH PAYMENT
For returns WITHOUT PAYMENT
________________________________
Signature:
Please remit to:
Please remit to:
City of Florence, Kentucky
City of Florence
12
31
2017
__________ / _______ / __________
P.O. Box 1357
Attn: Finance Dept
Date:
Florence, KY 41022 - 1357
8100 Ewing Blvd.
Florence, KY 41042
I declare, under the penalties of perjury, that this return has been examined, and to the best of my knowledge, is a true, correct, and complete return.C
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