Occupational License Account Information Update Form - Campbell County & Cities, Kentucky
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2Occupational License Account Information Update Form
Campbell County & Cities, Kentucky
F
O
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O
OR
FFICE
SE
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D
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_______________
ATE
EYED
Campbell County Fiscal Court Occupational License Office 1098 Monmouth St. Newport, KY 41071
I
___________________
NITIAL
Mail to: Campbell County Occupational License Dept, PO BOX 72958, Newport, KY 41072-0958
Phone: (859) 292-3884
Fax: (859) 292-3827
website
:
READ CAREFULLY
INSTRUCTIONS ON THE REVERSE
PLEASE TYPE OR PRINT LEGIBLY
THIS FORM MAY BE USED ONLY TO NOTIFY THE OCCUPATIONAL LICENSE OFFICE OF BUSINESS ADDRESS,
TELEPHONE NUMBER AND OTHER BUSINESS INFORMATION CHANGES. IT IS NOT TO BE USED IN PLACE OF A
LICENSE APPLICATION FORM.
1. CAMPBELL COUNTY TAX ACCOUNT ID#: ______________________
2. LEGAL BUSINESS NAME: _________________________________________________________________________________________________
3. TRADE NAME or DBA (if other than #2 above):
_______________________________________________________________________________
COMPLETE ANY BUSINESS INFORMATION CHANGES IN THE APPLICABLE SECTIONS BELOW:
4. Check One:
Individual / Sole Proprietor (please note on Line 2 if an LLC)
Partnership (attach a list of general partners names, home addresses & SSN)
Corporation (attach a list of officers names, home addresses & SSN)
Non-Profit Organization (attach IRS determination of status)
-
-
-
5. Federal ID No.
OR Social Security No.
(Individual/Sole)
6. Primary Business Address or Corporate Headquarters:
.
7
Campbell County, Kentucky Business Location:
No P.O. Box
No P.O. Box
Contact Name ___________________________________________
Contact Name ___________________________________________
Address________________________________________________
Address________________________________________________
________________________________________________
________________________________________________
City
_________________________State____ Zip Code _______
City
_________________________State____ Zip Code _______
Telephone (
) _________________________
Telephone (
) _________________________
8. Mailing Address for Quarterly Payroll Withholding Forms
9. Mailing Address for Annual Business Return
(Employers Only):
___ CHECK HERE IF THIS IS A PAYROLL COMPANY ADDRESS
___ CHECK HERE IF THIS IS A CPA OR PAID TAX PREPARER
Contact Name ___________________________________________
Contact Name ___________________________________________
Address________________________________________________
Address________________________________________________
________________________________________________
________________________________________________
City
_________________________State____ Zip Code _______
City
_________________________State____ Zip Code _______
Telephone (
) _________________________
Telephone (
) _________________________
10. Is change of address the result of a change in business entity?
YES
NO
11. Is change of address the result of sale or acquisition of business?
YES
NO
12. Is change of address the result of change in accountant and/or payroll company?
YES
NO
13. Signature of Person Completing Form
X
Date:
Phone:
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