Business Privilege License/gross Receipts License Fee Return Form

Business Privilege License/gross Receipts License Fee Return Form - City Of Radcliff Page 3

*Please note: If a federal tax extension is filed with the IRS, a copy of the extension must

be provided to the City of Radcliff and an estimated license fee must be paid (105 days

from the Close of the Taxable Year). Any adjustments will be made upon receipt of

the actual return. In addition, interest will be paid at a rate of 1% per month on the

estimated fee from the time the fee was due until the actual return is filed and any

additional fees paid.

Return must be signed. I hereby certify, under penalty of perjury/ that the statements

made herein and in any supporting schedules are true, correct, and complete to the best of

my knowledge.

___________________________________

_________________________________

Preparer’s Signature

Date

Licensee’s Signature

Date

___________________________________

_________________________________

Printed Name

Phone #

Printed Name

Phone #

Make check payable and mail to:

Forms are available on the internet at:

City of Radcliff

Finance Office

PO Box 519

Radcliff, KY 40159-0519

Business Privilege License/gross Receipts License Fee Return Form - City Of Radcliff Page 3