Occupational Business License Registration Application Form - Allen County, Ky
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1ALLEN COUNTY, KY
Occupational Business License Registration Application
License Acct. #
Mail To:
Occupational Tax Administrator
P.O. Box 115
201 West Main Street, Suite 5
Scottsville, KY 42164
(270) 237-3631
- (270) 237-9155 Fax
Telephone
Be it ordered and ordained by the Fiscal Court of Allen County, Kentucky, pursuant to Kentucky
Constitution Section 181 and KRS 67.083(2).
Definition: The phrase “License Fee” shall mean a tax imposed for the privilege of exercising the
right to engage in trade, occupation or profession or commissioned labor or compensation paid by
others or the right to engage in business for one’s profit or gain within Allen County, Kentucky
boundaries at the rate/or equal to one (1) percent of gross, less expenses. No fee charge for license.
BUSINESS NAME____________________________________________________________________________
OWNER NAME(S)____________________________________________________________________________
___Individual
___Partnership ___Corporation (Date organized _____/_____/_____State_______)
ADDRESSES
A. Location Address: ____________________
B. Mailing Address: _______________________
____________________
_________________________
____________________
Website:
_________________________
Location Phone: ____________________
E-Mail Address: _________________________
Driver’s Lic.#
Location Fax:
____________________
_________________________
Local Manager/Rep Name: _____________________________________ Phone: ____________________
NATURE OF BUSINESS: (Please describe your business and its operation, including where and how sales,
services, or other activities take place. Include site where working here on particular contract):
____________________________________________________________________________________________
OPERATION IN ALLEN COUNTY STARTED _____/_____/_____
Mo
Day
Yr
DO YOU HAVE OR WILL HAVE EMPLOYEES WORKING IN ALLEN COUNTY? ____YES_____NO
A. Number of Employees_____
B. Estimated Quarterly Payroll $__________
ACCOUNTING PERIOD: _____Calendar Year - Dec. 31 or _____Fiscal Year Ended _____/_____
Mo.
Day
BUSINESS FEDERAL IDENTIFICATION NUMBER____________________________________________
BUSINESS OWNER(S) SOCIAL SECURITY NUMBER(S)________________________________________
IF BUSINESS WAS OBTAINED FROM A PREVIOUS OWNER:
A. Give Date of Acquisition______________B. Give Name of Previous Owner:__________________________
I HEREBY CERTIFY THAT ALL INFORMATION AND STATEMENTS HEREIN ARE TRUE AND CORRECT.
DATE:_____________SIGNATURE:________________________________PRINT:_____________________
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