Form 102 - Net Profit And Shively Occupational Tax Report Form

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Form _______________
20 ______
PART I - All Licensees Must Answer The
Questions Below
NET PROFIT AND SHIVELY OCCUPATIONAL TAX REPORT
A. What is your Social Security Number
(if any)? _____________________________________
City of Shively, Jefferson County, Kentucky
Your Federal Tax Identification Number
For Year
(if any)? _____________________________________
Ended
B. What is your Principal Business Activity? ___________
Month
Day
Year
C. During the past year, did Federal Authorities change or
propose to change net income as reported for that year
or any prior year? _____________________________
(If yes, attach statement of changes.)
D. Do you have more than one place of business in
Jefferson County (including Shively)? _____________
Print
(if yes, you must complete Schedule 1 on reverse side.)
Name &
Address
E. Was there a change in ownership, or did you cease
doing business during the past year? ___________
(If yes, complete Schedule 2, reverse side.)
F. Did you file a corporate consolidated Federal return?
_____________
Did you file a corporate consolidated Kentucky return?
_____________
Change
If Incorrect
PART II - Complete Only The Section Which Applies To You. Please Attach A Copy of Federal Forms.
SECTION A - To Be Completed By Individuals Only
1.
Gross Employee Compensation (salary, etc.) earned in Shively from which no occupational
fees were withheld. Enter here and in appropriate column(s) on Line 4 of Part III ........................
$
2.
Gross Receipts per Schedule C, Schedule E, and Schedule F. .......................................................
3.
Total Business Expenses (Deductions per Federal Schedule C, Schedule E, and Schedule F.....
4.
Business Net Profits (Line 2 minus Line 3) ........................................................................................
5.
Enter Net Adjustment from Schedule 3 (reverse side of this form) .................................................
6.
Adjusted Net Profit (Line 4 plus Line 5). Enter here and in Part III, Line 1 ......................................
$
SECTION B - To Be Completed By Partnerships and Corporations
1.
Total Income per Federal Form 1065, 1120, 1120S, 1120L or 1120M, as applicable ........................
$
2.
Total Deductions per Federal Form 1065, 1120, 1120S, 1120L or 1120 M, as applicable ................
3.
Enter total on Line 1, above, less total on Line 2 ...............................................................................
4.
Enter any adjustments from Schedule 3, reverse side of this form .................................................
$
5.
Adjusted Net Profit (Line 3 plus Line 4). Enter here and in Part III, Line 1 ......................................
PART III - All Licensees Must Complete This Part
$
1.
Enter Adjusted Net Profit from either Section A (Line 6) or Section B (Line 5), as applicable ......
TOTAL
SHIVELY
2. Percentage Line 4, Schedule 4
%
%
3. Net Profits Allocation (Line 1 x Line 2)
4. Enter employee compensation from Section A, Line 1, Part II
5. Enter totals of amounts on Line 3 and 4 but not less than
amounts on Line 4
6. Occupational License Fees
1.50%
7. Total Fee Due__________________________________________________
$
8. Credit for License Fee Paid_______________________________________
$
9. Balance Tax Due________________________________________________
$
10. Minimum License Fee Due (See instruction sheet)____________________
$
11. Penalty and Interest_____________________________________________
$
12. Amount to be Paid_____________________________________
$
13. Credit Due____________________________________________
$
I hereby certify that the statements made herein and in any supporting schedules are true, correct, and complete to the best of my knowledge.
RETURN
MUST BE
SIGNED
Signature of Individual Preparing Return
Date
Signature of Licensee
Date
MAKE CHECKS PAYABLE AND MAIL TO: CITY OF SHIVELY, 3920 DIXIE HWY, SHIVELY, KY 40216
Form 102 2/08

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