Reconciliation Of Frankfort License Fee Withheld For Calendar Year Required Form
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1I HEREBY CERTIFY THAT THE INFORMATION AND STATEMENTS CONTAINED HEREIN
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1. MUST ENTER NUMBER OF TOTAL EMPLOYEES
TAXABLE EMPLOYEES
AND ANY SCHEDULES OR EXHIBITS ATTACHED ARE TRUE AND CORRECT.
2. TOTAL SALARIES, WAGES, COMMISSIONS AND OTHER
COMPENSATION PAID
3. LESS COMPENSATION PAID FOR SERVICES OUTSIDE OF
FRANKFORT
SIGNED __________________________________________________
4. TAXABLE EARNINGS (ITEM 2 MINUS ITEM 3)
OFFICIAL TITLE ____________________
DATE ______________
5. ACTUAL TAX DUE IN QUARTER AT 1.75%
$
6. ADJUSTMENTS (PRIOR QUARTERS)
Telephone 502-875-8504
7. INTEREST – 1% PER MONTH OR PORTION OF MONTH UNTIL PAID
Fax 502-875-8502
8. PENALTY – 5% PER MONTH OR PORTION OF MONTH NOT TO EXCEED 25%,
HOWEVER IT SHALL NOT BE LESS THAN $25.00.
Please make copy for your records
9. TOTAL TAXES DUE INCLUDING INTEREST & PENALTY
*IF NO WAGES WERE PAID THIS QUARTER, MARK “NONE” AND RETURN
ACCOUNT NO.
FOR QUARTER ENDING
DUE ON / OR BEFORE
NAME
&
ADDRESS
TOTAL FRANKFORT LICENSE FEE WITHHELD
QUARTER ENDED MAR. 31 ______________
OF
QUARTER ENDED JUNE 30 _______________
EMPLOYER
QUARTER ENDED SEPT 30 _______________
Make Check Payable to:
Mail To: LICENSE FEE DIVISION
QUARTER ENDED DEC 31 ______________
DIRECTOR OF FINANCE
MUNICIPAL BUILDING
P.O. BOX 697
TOTAL REMITTED FOR YEAR __________________
FRANKFORT, KY 40602
RECONCILIATION OF FRANKFORT LICENSE FEE WITHHELD FOR CALENDAR YEAR REQUIRED
(IF YOU HAVE LESS THAN 10 EMPLOYEES USE THE SPACE PROVIDED BELOW OR FURNISH COPIES OF EMPLOYEE’S W-2, LARGER CONCERNS MAY FILE OWN
LISING (SAME FORMAT BELOW) OR FURNISH W-2 COPIES.
SOCIAL SECURITY NUMBER
NAME OF EMPLOYEE
GROSS WAGES
TAXABLE WAGES
OCCUPATIONAL LICENSE
WITHHELD
IF REPORT IS COMPLETE ON THIS PAGE TOTAL HERE
PREPARED BY __________________________________________________________
ATTACH CONTINUATION SHEET(S) IF NECESSARY
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