Form 501q - Washington County Occupational License Fee Withheld

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County of Washington
form 501Q
EMPLOYER'S
QUARTERLY
RETURN
WASHINGTON
COUNTY OCCUPAIIONAL
LICENSE FEE WITHHELD
Account Number
1
Total salaries,
waqes, commissions,
and other
2. Amount on line 1 subiect to Washinoton
Countv Fee
License Fee P
o f 1 % o f l i n e 2
for Fractions
5
Interesl
this ouarter
6. TotalAmount
Due (Sum of lines 3. 4 anqlL
7. Total Number of Emplovees
subject to Washington
L_icensefgq
tfillglql
I declare this rs a true, correct and complete return tor the quafier ending
Company
Name
Srgnature
Date
Title
INSTRUCTIONS FOR COMPLETING YOUR RETURN
The relurn is lor a period ol three calendar months ending Mafch 31, June 30, September 30 or December 31,
and is dlq on or betorethe lastday ol the month tollowing the end ol the ouarter.
Line 1: Entertota compensation
pad dlrrng the qlartea regafdless
when or where earned
Line 5: Inleresl accrues on unpaid license fees al a rate ol 12oo pef annum trom the due date of the retum Ltntilpaid.
Make checks payable and mail with this card to:
Washtngton
Cccupatronal
License Adminrstrator
(WCOTA).
P.O Box 228 Springfield,
KY 40069 . (859) 336-5430
More detatled nformatron for employers
can also be obtained from this office.

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