Employer'S Return Of Occupation License Fee Withheldfrom Salaries, Wages, Commissions, And Other Compensation

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FINANCE DEPARTMENT
REVENUE OFFICE
144 Tichenor Avenue, Suite 6
AUBURN, AL 36830
(334) 501-7228
City of Auburn
Name: _______________________________________
Address: _____________________________________
_____________________________________________
City: ________ State: __ Zip Code: _______________
EMPLOYER’S RETURN OF OCCUPATION LICENSE FEE WITHHELD
FROM SALARIES, WAGES, COMMISSIONS, AND OTHER COMPENSATION UNDER
ORDINANCE 416, AS AMENDED BY ORDINANCE 1096
DECLARATION
UNDER THE PENALTIES OF PERJURY, I DECLARE THAT THIS RETURN IS TRUE, CORRECT, AND
COMPLETE AS REQUIRED BY CITY ORDINANCE.
SIGNATURE: __________________________________
TITLE: _______________________________________
DATE FILED: __________________________________
MAKE CHECK PAYABLE TO “CITY OF AUBURN”. IF RECEIPT IS DESIRED, PLEASE ENCLOSE SELF-
ADDRESSED STAMPED ENVELOPE.
MAIL TO: CITY OF AUBURN
144 TICHENOR AVENUE, SUITE 6
AUBURN AL 36830
1.
NUMBER OF TAXABLE EMPLOYEES THIS QUARTER
____________________________
2.
GROSS WAGES PAID DURING THIS QUARTER TO
____________________________
EMPLOYEES REPORTED ON LINE 1 FOR WORK IN
THE CITY OF AUBURN
3.
OCCUPATION LICENSE FEE WITHHELD DURING
____________________________
THIS QUARTER FROM WAGES PAID TO EMPLOYEES
(1% OF LINE 2)
4.
INTEREST (1/2 OF 1% OF LINE 3, PER MONTH,
____________________________
IF DELINQUENT)
5.
PENALTY (10% OF LINE 3, BUT MINIMUM OF $1.00,
____________________________
IF DELINQUENT)
6.
TOTAL AMOUNT DUE (LINE 3 PLUS LINES 4 AND 5)
____________________________
QUARTER FILED FOR:
DUE:
DELINQUENT AFTER:
PERIOD ENDING:

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