Reconciliation Of License Fee Withheld Form - Kentucky License Fee Division

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Mail To:
CITY OF OWENSBORO, KENTUCKY
CITY OF OWENSBORO
LICENSE FEE DIVISION
Phone:
P. O. Box 10003
RECONCILIATION OF LICENSE FEE WITHHELD
(270) 687-8530
Owensboro, KY 42302-9003
YEAR ENDED _____
(270) 687-8529
___________________________________________________________________________________________________________
Type or print in this space Employers Name
Total number of employees listed hereon
and Address or Principal Place of Business
ANNUAL RECONCILIATION
Col. A
Col. B
Monthly
Quarterly
Filing
Filing
Jan.
Feb.
Mar.
1st
Apr.
May
June
2nd
INSTRUCTIONS
Complete Annual Reconciliation of payments using applicable
July
column.
Aug.
Sept.
3rd
Complete columns 1 thru 5 below for each employee or attach
copies of W-2’s. **Note: If attaching W-2’s provide total city wages in
Oct.
column 4, providing total subject at 1.33% and total subject at 1%!
Nov.
Dec.
4th
Column 2 should include Gross Federal wages that are subject to the
license fee.
Include in column 3 all income from deferred compensation, applicable
group term life insurance premiums, personal use of employer provided
automobile, excess reimbursed employee business expense and all other
*
subject compensation not included in Column 2.
Note: Amount in Column 4 must equal
*Total occupational license fee withheld in Column 5 must
Column 2 plus Column 3 for each employee.
equal total payments in annual reconciliation.
Col. 1
Col. 2
Col. 3
Col. 4
Col. 5
FEDERAL WAGES
OTHER SUBJECT
SUBJECT TO
COMPENSATION
TOTAL
OCCUPATIONAL
EE
(Identify)
CITY WAGES
LICENSE F
LD
FEE WITHHE
NAME OF EMPLOYEE
**
1.33%
If report is completed on this page, total
1.0%
here. **In Column 4, provide
total city wages subject at 1.33% and
TOTAL
total city wages subject at 1%.
*
Prepared By ______________________________
CONTINUED ON BACK

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