Employer'S Amended Return Of License Fee Withheld Form - City Of Owensboro

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CITY OF OWENSBORO AND DAVIESS COUNTY FISCAL COURT
(FOR PERIODS ENDING AFTER
EMPLOYER’S AMENDED RETURN OF LICENSE FEE WITHHELD
6/30/05 ONLY)
NAME AND ADDRESS
Account No.:
Period Beginning:
Period Ending:
Due Date:
Type:
PART I (COMPLETE PART II ON BACK)
I
II
III
As Originally
Net Change
Reported or Adjusted
Increase or Decrease
Correct Amount
WAGE INFORMATION: FROM FORM EQ-1
TOTAL GROSS WAGES, SALARIES AND OTHER
COMPENSATION PAID:
1A. City of Owensboro…………………………………
1B. Daviess County…………………………………….
LESS COMPENSATION NOT SUBJECT TO
LICENSE FEE:
2A. City of Owensboro…………………………………
2B. Daviess County…………………………………….
EARNINGS SUBJECT TO LICENSE FEE:
3A. City of Owensboro (Line 1A minus Line 2A)……
3B. Daviess County (Line 1B minus Line 2B)…………..
LICENSE FEE DUE:
4A. City of Owensboro (1.33% of Line 3A)……………..
4B. Daviess County ( .5% of Line 3B)………………...
PENALTY: (5% per calendar month not to exceed 25%,
$25 minimum)
5A. City of Owensboro………………………...............
5B. Daviess County…………………………………….
INTEREST: (1% per calendar month or fraction thereof)
6A. City of Owensboro…………………………..............
6B. Daviess County………………………………………
TOTAL AMOUNT DUE:
7A. City of Owensboro (Add Lines 4A, 5A and 6A)…
7B. Daviess County (Add Lines 4B, 5B and 6B)……….
PAYMENTS AND CREDITS
LICENSE FEE, INTEREST AND PENALTY PAID WITH ORIGINAL RETURN:
8A. City of Owensboro…………………………………………………………………………………….
8B. Daviess County…………………………………………………………………………………………
PAYMENTS OR CREDITS NOT CLAIMED ON THE ORIGINAL RETURN:
9A. City of Owensboro…………………………………………………………………………………….
9B. Daviess County…………………………………………………………………………………………
TOTAL PAYMENTS AND CREDITS:
10A. City of Owensboro (Line 8A plus Line 9A)…………………………………………………………...
10B. Daviess County (Line 8B plus Line 9B)……………………………………………………………..
Continued on Back

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