Net Profits License Fee Return Form - City Of Dawson Springs, Ky
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1CITY OF DAWSON SPRINGS, KY
NET PROFITS LICENSE FEE RETURN
_____________________________________________________________________
____________________________________________________
Make Check Payable & Mail to:
BUSINESS NAME
City of Dawson Springs
P. O. Box 345
Dawson Springs, KY 42408
____________________________________________________
ADDRESS
____________________________________________________
CITY, STATE, ZIP
*Enclose one copy of Federal Return & Applicable Schedules (See Instructions)
1. Net Profits Subject to License Fee per attached Federal Return
__________________
2.
Dawson Springs License Fee @ 1 ½ % to $50,000; 1% of $50,000 thru $500,000,
and ½ % over $500,000 with minimum of $50.00.
____________________
3.
If Allocation (Line D) is used enter Average Percentage
___________________%
4.
Net Profits subject to License Fee (Line 2 x Line 3)
____________________
5. Credit – Minimum License Fee
____________________
6. Balance (Line 2 less Line 3)
____________________
7. Penalty 5% per month or portion of month, not to exceed 25%;
$25.00 minimum penalty.
____________________
Penalty waived per approved City – extension date of _______________
8. Interest 12% per annum if delinquent
____________________
9. TOTAL Due (Line 6, 7 and 8)
PAY THIS AMOUNT
$ _________________
10. Circle Appropriate: Corporation, Partnership, Individual Owner, Fiduciary
11. Social Security or Federal ID Number
___________________
12. Total number of employees during previous year.
___________________
13. Was Dawson Springs Earnings Fee Withheld from all employees and remitted quarterly? ____________
Column A
Allocation Factors
Column B Total
Column C
DawsonSprings
Pct
A.
Gross Income (If not applicable write N/A in Column C)
%
B.
Total Wages & Salaries (if not applicable write N/A Col C
%
C. Total Percents (Line A plus Line B)
%
D. Average Percentage (Line C divided by number of applicable percents) Enter on Line 3
%
I hereby certify that the statements made herein and attached copy of Federal Income Tax Return and all supporting statements
and schedules are true, correct and complete to the best of my knowledge.
__________________________________________
__________________________________________
Signature of License Fee Payer
Date
Signature of Individual Preparing Return
Date
Due by April 15 of each year
th
Or by 15
day of fourth month following close of fiscal year
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