Form Mc100 - Employer'S Return Of License Fee Withheld printable pdf download

Form Mc100 - Employer'S Return Of License Fee Withheld

Madison County Finance Office

EMPLOYER'S RETURN OF LICENSE FEE WITHHELD

If no wages were paid this period, mark "NONE" and return this form

1. Number of Employees

8. BALANCE DUE (total line 5+6+7)

(

l li

6 )

2. Salaries, wages and commissions paid to employees performing services.

3. Adjustment of exempt wages (outside Madison Co.)

I hereby certify that the information, schedules, statements, and exhibits field herewith are true and correct.

4. Taxable earnings Madison Co.

5. TOTAL LICENSE FEE DUE (LINE 4 X .01)

Signed _________________________________________________________________________________

6. Late Filing Penalty ‐ 5% per month, max of 25%, Min. $25.00

7. Interest Penalty ‐ 12% per annum or portion of year.

Official Title ________________________________________________

Date ___ /__ ___ /_______

PLEASE MAKE CHECKS

Account Number

FOR PERIOD ENDING

Payable and mail to:

Month

Day

Year

Madison County

Finance Office

P.O. Box 547

Phone Number

RETURN DUE ON OR BEFORE

Richmond, KY 40476‐0547

Month

Day

Year

Phone: (859) 624‐4742

Indicate any name or address change above.

Fax: (859) 624‐4027

* PLEASE MAKE A COPY OF THIS FORM FOR YOUR RECORDS. ffffffffffff

Form MC100 Rev. 05/15/2007

Form Mc100 - Employer'S Return Of License Fee Withheld