Annual Reconciliation Of Occupational License Fees Withheld - Nicholasville

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ANNUAL RECONCILIATION OF OCCUPATIONAL LICENSE FEES WITHHELD
For the Year Ended December 31, ________
Check if Address Has Changed ____
Federal ID No.______________
Account # _______________
Business Name _________________________________________________
Phone: (
)
-
Address __________________________________ City________________ State_______ Zip ________
__________________________________________________________________________________________
1. Total Gross Wages and Other Compensation Paid during the Year
$ _______________
2. Less Compensation Paid for Services Performed Outside Nicholasville
$ _______________
3. Taxable Compensation (line 1 minus line 2)
$ _______________
4. License Fee Due (line 3 x 1.5%)
$ _______________
5. License Fees Remitted with Quarterly Returns:
st
A. Quarter Ended March 31
_______________
th
B. Quarter Ended June 30
_______________
th
C. Quarter Ended September 30
_______________
st
D. Quarter Ended December 31
_______________
Total Fees Remitted (lines A thru D)
$ _______________
6. Difference (Line 4 minus line 5)
$ _______________
-If any, check applicable box below
Minor difference due to fractional variations only -- No adjustment needed
Difference indicates an underpayment -- Payment enclosed
Difference indicates an overpayment -- An amended return for the period overpaid must be filed
separately with a letter of explanation.
__________________________________________________________________________________________
7. License Fees Due (from line 4 above)
$ _______________
8. Actual License Fees Withheld per Box 19 of W-2’s
$ _______________
9. Difference (line 7 minus line 8)
$ _______________
-Please attach explanation of any difference
__________________________________________________________________________________________
The original of this reconciliation along with a copy of the W-2’s must be filed with the City of Nicholasville on or
th
before February 28
to the following address:
City of Nicholasville, P.O. Box 590, Nicholasville, KY 40340-0590
Telephone: (859) 885-7618 Fax (859) 885-9476
I hereby certify that this information is true and correct to the best of my knowledge.
Signature
Date
Print Name
Title
C:\Documents and Settings\acampbell\Local Settings\Temporary Internet Files\OLK13A\annual reconciliation - payroll tax.docRevised 7/11/13

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