Reconciliation Of License Fee Withheld Form - City Of Owensboro, Kentucky
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1
2Mail To:
CITY OF OWENSBORO, KENTUCKY
CITY OF OWENSBORO
LICENSE FEE DIVISION
Phone:
P. O. Box 10003
RECONCILIATION OF LICENSE FEE WITHHELD
(270) 687-8534
Owensboro, KY 42302-9003
YEAR ENDED _____
(270) 687-8530
___________________________________________________________________________________________________________
Total number of employees listed hereon
Type or print in this space Employers Name
ANNUAL RECONCILIATION
and Address or Principal Place of Business
Col. A
Col. B
Monthly
Quarterly
Filing
Filing
Jan.
Feb.
Mar.
1st
Apr.
May
INSTRUCTIONS
June
2nd
July
Complete Annual Reconciliation of payments using applicable
column.
Aug.
Sept.
3rd
Complete columns 1 thru 5 below for each employee or attach
Oct.
copies of W-2’s. If attaching W-2’s provide total city wages in column 4!
Nov.
Column 2 should include Gross Federal wages that are
Dec.
4th
subject to the license fee.
Include in column 3 all income from deferred compensation,
applicable group term life insurance premiums, personal use
of employer provided automobile, excess reimbursed employee
*
business expense and all other subject compensation not
included in Column 2.
Note: Amount in Column 4 must equal Column 2 plus Column 3
*Total occupational license fee withheld in Column 5 must equal
for each employee.
total payments in annual reconciliation
.
Col. 1
Col. 2
Col. 3
Col. 4
Col. 5
FEDERAL WAGES
OTHER SUBJECT
SUBJECT TO
COMPENSATION
TOTAL
OCCUPATIONAL
NAME OF EMPLOYEE
LICENSE FEE
(Identify)
CITY WAGES
FEE WITHHELD
IF REPORT IS COMPLETED
*
ON THIS PAGE - TOTAL HERE
Prepared By ______________________________
CONTINUED ON BACK
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