Form 2306 - Amended Quarterly Withholding Tax Return

Boone County Fiscal Court

2950 Washington Street

PO Box 960

Burlington, KY 41005

(859) 334-2144

(859) 334-3914 Fax

Amended Quarterly Withholding Tax Return for 2012

Name:

Account #: ________________________________________

dba:

FEIN/SSN:_________________________________________

(please advise if incorrect)

For Quarter Ending: - (Circle Correct Date)

Address:

03/31/12 due 04/30/12

09/30/12 due 10/31/12

City, State, Zip:

06/30/12 due 07/31/12

12/31/12 due 01/31/13

Original

Amended

Total Gross Earnings of All Employees Working in Boone County

Boone County Board of Education Tax - 1/2 of 1% (.005)

*****No Maximum*****

Original

Amended

1) Gross earnings subject to Boone County Board of Education tax

2) Multiply Line 1 - by 1/2 of 1% (.005)

3) Interest Fee 1% per month, 12% per year

Less credit for overpayment in prior quarter-attach explanation

Difference

5) Total Board of Education Tax

Boone County Ordinance #07-27- 8/10 of 1% (.008)

*****Max $55,594.00/tax of $444.75 PER EMPLOYEE*****

Original

Amended

6) Gross earnings subject to Boone County payroll tax

7) Multiply Line 6 - by 8/10 of 1% (.008)

8) Interest Fee 1% per month, 12% per year

Less credit for overpayment in prior quarter-attach explanation

10)

Less any KY Job Assessment Program credit

Difference

11) Total Boone County Ordinance Tax

Boone County Mental Health Tax Ordinance #07-26- 15/100 of 1% (.0015)

*****Max $16,666.00/tax of $25.00 PER EMPLOYEE*****

Original

Amended

12) Gross earnings subject to Mental Health Payroll tax

13) Multiply Line 12 by 15/100 of 1% (.0015)

14) Interest Fee 1% per month, 12% per year

15)

Less credit for overpayment in prior quarter-attach explanation

Difference

16) Total Mental Health Tax

Total remittance (add lines 5,11,16)

Payment

Credit to MM/YY or Refund

Make check payable to: Boone County Fiscal Court

If the amended return results in a overpayment you can request the amount to be a credited to another quarter or will be refunded after year end processing.

Statistical Information-REQUIRED

Total Number of Employees Working in Boone County

Signed:

Date:

Official Title:

Telephone Number:

Tax Form Prepared By:

I declare, under the penalties of perjury, that I have examined this document and to the best of my knowledge and belief, this is a true and accurate return.

Please notify in writing any changes of ownership or new address by completing a Request to Change/Close Occupational License Account which can be found

on our website @ If you have any questions please call 859-334-2144 or email

Make check payable to: Boone County Fiscal Court

Mail your return to:

(PO Box 457, Florence, KY 41022-0457) are for returns WITH PAYMENT and

(PO Box 960, Burlington, KY 41005-0960) are for returns WITHOUT PAYMENT

Form 2306