Employers' Annual Reconciliation Of License Fee/tax Withheld Form
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1CITY OF COVINGTON, KENTUCKY
For Year Ended
Month Day
Year
EMPLOYERS' ANNUAL RECONCILIATION OF
LICENSE FEE/TAX WITHHELD
Account #
Print Name & Mailing Address of Employer
TO:
Social Security# or
Federal ID #
WITHHOLDING PAYMENT SCHEDULE
Jan
April
July
Oct
Feb
May
Aug
Nov
June
Sept
Dec
March
Number of Employees:
Total Payments
$
FEE COMPUTATION
*****IMPORTANT*****
1) Total Wages, Tips, Other Compensation per Box 1 of Federal
Form W-2 or W-3
2) Add Deferred Compensation Contributed by Employees
Enclose Copies of Federal
3) Add Welfare Benefit, Fringe Benefit, or Other Benefit Plan
Forms W-2 and W-3,
Payments Contributed by an Employee
Transmittal of Wage and
Tax Statements, or a
4) Total Gross Compensation (Add Lines 1 through Line 3)
Detailed Employee Listing
with the Required
5) Less Total Gross Compensation Paid for Service Outside
Equivalent Information
City of Covington and Portion of Earnings over FICA Maximum
6) Taxable Compensation (Subtract Line 5 from Line 4)
7) Occupational License Fee
(Line 6 X 2.50% )
DUE
FEBRUARY 28
8) Total Payments Remitted
9) Balance Due
10) Penalty @ 5% per month or portion thereof, not to exceed 25%,
Remit to:
minimum $25
CITY OF COVINGTON
638 Madison Ave.
11) Interest @ 1% per month from Due Date
Covington, KY 41011
12) TOTAL AMOUNT DUE
(859)292-2184
13) Overpayment Claimed
(If Line 8 Exceeds Line 7)
Credit to next year estimate pymt
Refund
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.
SIGNATURE
TITLE
DATE
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