Occupational License Application Form Page 2
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1
2For LLC, LLP & Corporations: List the Names, Addresses and Social Security Numbers of Officers and Partners.
(OR attach a separate sheet containing the information)
8.
Campbell County, Kentucky Business Locations (Continued from #7 on Front Side) Attach additional list as necessary: No P.O. Box
Contact Name: ____________________Address_______________________________City ____________St. ___ Zip______Tel. (
) ___-____
Contact Name: ____________________Address_______________________________City ____________St. ___ Zip______Tel. (
) ___-____
Contact Name: ____________________Address_______________________________City ____________St. ___ Zip______Tel. (
) ___-____
Instructions for Filing the Occupational License Application
General Information: Any business operating in Campbell County, Kentucky is required to complete this occupational license application
(ref. Ordinance R-34-78, as amended). Campbell County Fiscal Court serves as the Occupational Tax collection agent for the Cities of
Alexandria, Cold Spring, Fort Thomas, Highland Heights, Melbourne, Southgate and Woodlawn, Kentucky. Any business operating in a city is
required to obtain an occupational license. Contact the Occupational License Office for more information or access our website
.
Instructions: Any Occupational License Application that is incomplete and/or incorrect will be returned to the applicant. Please be sure to
review the Occupational License Application to ensure that all requested information is included. Incomplete License Applications will be returned
and this may result in a delay in the processing the Occupational License. The license application fee is non-refundable.
1, 2. The License application fee for Campbell County is $25. If the business is operating in any city, the fee for Campbell County must also be checked and
paid. The fees will be credited against the business’ annual fee liability for the tax year. Non-profit organizations are required to complete the license
application but will be exempted from the Annual Net Profit License Fee only if they attach a copy of the IRS Non-Profit Determination.
3.
Check the box that describes the form of business organization. Attach any required documentation to the application.
4.
Fill in the complete legal business name of Individual, Partnership, Corporation or Company.
5.
Fill in the trade name or the name the company will conduct business under in Campbell County, Kentucky.
6.
Give a brief description of business activity (ex: grocery store; drug store; restaurant).
7.
Fill in the complete primary business address or corporate headquarters address with a contact person. No P.O. Box.
8.
Fill in the complete physical address of the business location Campbell County, Kentucky (if applicable). No P.O. Box.
9.
Fill in the complete mailing address to send Quarterly payroll withholding forms (for employers only).
10. Fill in the complete mailing address to send Annual Occupational Tax Return. Fill in the complete home address of the individual or sole proprietor.
11. Individuals/Sole Proprietors fill in their Social Security Number, one number to a box with no dashes or spaces. Corporations and Partnerships fill in the
business Federal Employer Identification Number, one number to a box with no dashes or spaces.
12. Corporations must indicate the LAST MONTH of the corporate fiscal year.
13. Enter the date on which the business began or will begin in Campbell County Kentucky (whether within or outside a City corporate limit(s).
14. Enter the date on which the business paid or will pay employees for work in Campbell County, Kentucky.
15. If the business will use leased or temporary employees, provide the name address and phone number of the leasing or temporary agency.
16. Check whether business uses independent contractors and list name, address and phone number of the independent contractor(s).
17. Indicate if the business was obtained from another owner or a change in organization occurred and provide information as requested.
18. Indicate whether any part of the business will be performed in a private residence.
19. SIGNATURE BOX: MUST INCLUDE Signature, Printed name, Title and Date.
If the license application is for an individual or sole-proprietorship, the individual must sign and date the form.
If the license application is for a partnership, a general partner must sign and date the form.
If the license application is for a corporation, a corporate officer must sign, include their title, and date the form.
Attach a check payable to “Campbell County Fiscal Court” and mail with application and attachments to:
Campbell County Fiscal Court
Occupational License Dept
PO Box 72958
Newport, KY 41072
City Zoning Department Telephone (ALL AREA CODE 859)
Campbell County Tax Partnership Cities
Other Campbell County Cities
Alexandria
635-4125
Bellevue
431-8866
Cold Spring
441-9604
California
292-3880
Fort Thomas
441-1055
Crestview
292-3880
Highland Heights
441-8575
Dayton
292-3880
Melbourne
292-3880
Mentor
292-3880
Southgate
292-3880
Newport
292-3637
Woodlawn
292-3880
Silver Grove
292-3880
Wilder
581-8884
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