Employer'S Return Of License Fee Withheld Form
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1UNION COUNTY TAX ADMINISTRATOR
EMPLOYER'S RETRUN OF LICENSE FEE WITHHELD
If no wages were paid this period mark "NONE" and return this form
1. Salaries, wages, commission & other compensation paid all
7. Overpayment to be credited o next quarter
employees for services in This County
2. Tax Due at -
0.50%
I hereby certify that the information, schedules, statements and exhibits
3. Adjustment for preceding quarters (past due balances /
filed herewith are true and correct.
underpayments
4. Penalty
5.00%
per mnth and portion of max 25% min $25
Signed
5. Interest
12.00%
per annum
6. BALANCE DUE
Official Title
Date
Account No.
FOR QUARTER ENDING
Make checks payable and mail to
Name:
Union County Tax Administrator
P.O. Box 60
Address:
RETURN DUE ON OR BEFORE
Moganfield, KY 42437
Phone:
(270) 389-3438
State
AL
City
Zip
Fax:
(270) 389-4232
FED ID NO. / SSN
Phone Number
*PLEASE MAKE A COPY OF THIS FORM FOR YOUR RECORDS
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Parent category: Financial