Form 1906 - Quarterly Withholding Tax Return - 2013

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Boone County Fiscal Court
2950 Washington Street
PO Box 960
Burlington, KY 41005
(859) 334-2144
(859) 334-3914 Fax
Quarterly Withholding Tax Return for 2013
Name:
Account #: ______________________________________
dba:
FEIN/SSN:________________________________________
For Quarter Ending: - (Circle Correct Date)
Address:
03/31/13 due 04/30/13
09/30/13 due 10/31/13
City, State, Zip:
06/30/13 due 07/31/13
12/31/13 due 01/31/14
Total Gross Earnings of All Employees Working in Boone County
Boone County Board of Education Tax - 1/2 of 1% (.005)
*****No Maximum*****
1) Gross earnings subject to Boone County Board of Education tax
$
0.00
2) Multiply Line 1 - by 1/2 of 1% (.005)
$
3) Late filing and/or Paying Penalty
$
( 5% per month, maximum not to exceed 25%,minimum $25)
4) Interest Fee (1% per month, 12% per year )
$
0.00
5) Total Board of Education Tax
$
Boone County Ordinance #07-27- 8/10 of 1% (.008)
*****Max $56,377.00/tax of $451.01 PER EMPLOYEE*****
6) Gross earnings subject to Boone County payroll tax
$
0.00
7) Multiply Line 6 - by 8/10 of 1% (.008)
$
8)
Less any KY or Boone Local Job Assessment Program credit
$
9) Late filing and/or Paying Penalty
$
( 5% per month, maximum not to exceed 25%,minimum $25)
10) Interest Fee (1% per month, 12% per year )
$
0.00
11) Total Boone County Payroll Tax
$
Boone County Mental Health Tax Ordinance #07-26- 15/100 of 1% (.0015)
*****Max $16,666.00/tax of $25.00 PER EMPLOYEE*****
12) Gross earnings subject to Mental Health Payroll tax
$
0.00
13) Multiply Line 12 - by 15/100 of 1% (.0015)
$
14) Late filing and/or Paying Penalty
$
( 5% per month, maximum not to exceed 25%,minimum $25)
15) Interest Fee (1% per month, 12% per year )
$
0.00
16) Total Mental Health Tax
$
Total remittance (add lines 5,11,16)
0.00
Make check payable to: Boone County Fiscal Court
$
Statistical
Information-REQUIRED
Total Number of Employees Working in Boone County
Signed:
Date:
Printed Name:
Official Title:
Tax Form Prepared By:
Telephone Number:
Payroll Processor:
E-mail Contact:
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 at If you have any questions please call 859-334-2144 or email:
Mail your return to:
(PO Box 457, Florence, KY 41022-0457) is for returns WITH PAYMENT
and
Form 1906
(PO Box 960, Burlington, KY 41005-0960) is for returns WITHOUT PAYMENT.

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