Whitley County Application For Occupational License Tax Form
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1WHITLEY COUNTY APPLICATION FOR OCCUPATIONAL LICENSE TAX
P. O. BOX 268 WLLIAMSBURG, KY 40769
PHONE 606-539-0477 FAX 606-539-0478
THERE IS NO FEE FOR THE OCCUPATIONAL LICENSE TAX APPLICATION QUESTIONNAIRE
NAME OF APPLICANT_______________________________________________________________________________________
BUSINESS NAME____________________________________________________________________________________________
EMPLOYEE NAME_______________________________________________________________________________________
If an Employee of the Federal Government, U. S. Post Office , (ie Internal Revenue Service, Social Security Adm. or other Agency).
BUSINESS ADDRESS (LOCAL)________________________________________________________________________________
CITY, STATE, AND ZIP_______________________________________________________________________________________
TELEPHONE NUMBER_____________________________FAX NUMBER_____________________________________________
DATE OPERATIONS BEGAN IN WHITLEY COUNTY_____________________________________________________________
DESCRIPTION OF THE NATURE OF BUSINESS___________________________________________________________
TYPE OF BUSINESS:________________________________________________________________________
I. E. Corporation, Partnership, Subchapter S. Corp., Limited Liability Co. Sole Proprietor , Non Profit, Governmental ( ETC. )
FEDERAL TAX ID NUMBER IF ASSIGNED OR SOCIAL SECURITY NUMBER______________________________________
CONTRACTORS: ATTACH A LIST ALL SUBCONTRACTORS AFFILIATED WITH YOUR WORK IN WHITLEY COUNTY.
PLEASE INCLUDE THEIR NAME, ADDRESS, TELEPHONE NUMBER AND FEDERAL ID NUMBER.
PARTNERSHIPS: ATTACH A LIST OF PARTNERS. PLEASE INCLUDE THEIR NAME, ADDRESS, AND SOCIAL
SECURITY NUMBER.
WITHHOLDING INFORMATION
** IF DIFFERENT FROM ABOVE **
CONTACT PERSON:_________________________________________________________________________________________
MAILING ADDRESS_________________________________________________________________________________________
CITY STATE AND ZIP________________________________________________________________________________________
TELEPHONE NUMBER_______________________________FAX NUMBER___________________________________________
NET PROFIT INFORMATION
** IF DIFFERENT FROM ABOVE **
CONTACT PERSON: _________________________________________________________________________________________
MAILING ADDRESS_________________________________________________________________________________________
CITY, STATE, AND ZIP_______________________________________________________________________________________
TELEPHONE NUMBER___________________________________FAX NUMBER_______________________________________
CLOSING MONTH OF ACCOUNTING YEAR_________________/_______________/_________________________________
Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief it is true,
correct, and complete.
Signature__________________________________Title_______________________________Date__________________
OFFICE USE ONLY: ACCOUNT#__________________________________
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