Form Ol-3a - Occupational License Tax Return
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1
2DO NOT STAPLE FORMS
FOR OFFICIAL USE ONLY
FORM
LOUISVILLE METRO REVENUE COMMISSION
3
OL-
A
OCCUPATIONAL LICENSE TAX RETURN
CHECK IF “FINAL RETURN”
Date Operations Ceased: _____________ (Required to close account.)
CHECK IF “NO ACTIVITY” FOR YEAR
CHECK IF CHANGE IN ADDRESS IS BELOW
CHECK IF THIS IS AN AMENDED RETURN
ACCOUNT NUMBER
Name
____________________________________________________________________________
Address
____________________________________________________________________________
FOR YEAR ENDING
MM
DD
YY
City
_____________________________________________
State ________
Zip _________
Phone No.
____________________________
Ext _________
SSN _________________________
Income or (Loss):
1.
Amount of Net Profit per your federal Schedule C
(Attach a copy of Schedule C of Form 1040)
1.) $________________
2.
Add: Occupational taxes deducted on Schedule C
2.) $________________
3.
Adjusted Net Profit (Line 1 + Line 2)
3.) $________________
Tax Computation:
Do you live in Louisville Metro, Kentucky? If “yes”, complete Section A. If “no”, complete Section B.
Section A. Residents of Louisville Metro, Kentucky:
4.
Adjusted Net Profit per Line 3 above
4.) $________________
5.
Tax Due [Multiply Line 4, Section A, by (.0220)]
5.) $________________
6.
Penalty and Interest
6.) $________________
7.
Amount to be paid (Line 5 + Line 6)
7.) $________________
Section B. Non-residents of Louisville Metro, Kentucky:
4.
Adjusted Net Profit per Line 3 above
4.) $________________
5.
Tax Due [Multiply Line 4, Section B, by (.0145)]
5.) $________________
6.
Penalty and Interest
6.) $________________
7.
Amount to be paid (Line 5 + Line 6)
7.) $________________
I hereby certify, under penalty of perjury, that the information provided and the attached supporting schedules are true, correct, and
complete to the best of my knowledge.
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/
/
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Preparer’s Signature (Return must be signed.)
Date
Signature of Licensee (Return must be signed.)
Date
Print Name
Federal ID
Print Name
Title
Address
Phone No.
Social Security Number
Federal ID, if any
ATTENTION: Federal ID Numbers and Social Security Numbers must be supplied for both the Tax Preparer and the Licensee.
Mail Form OL-3A, along with a copy of the federal Schedule C, and a check or money order with your account number. The return
th
and payment of taxes due must be received or postmarked by April 15
to avoid penalties and interest.
MAILING ADDRESS: P.O. BOX 35410 LOUISVILLE, KENTUCKY 40232-5410
Telephone: (502) 574-4860 Fax: (502) 574-4818 TDD: (502) 574-4811
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Parent category: Financial