Extension Request Form - City Of Florence - 2017
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12017 EXTENSION REQUEST
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Due the 15
day of the 4
month following the close of the taxable year end
Business name: ______________________
Tax year ended: ___________________
Address:
______________________
Due date:
___________________
Address:
______________________
Federal ID/SS #: ___________________
City/State/Zip:
______________________
Phone #:
___________________
Business Entity
Make payable to: City of Florence
Classification:
Remit to:
P.O. Box 1327
___ Individual
Florence, KY 41022-1327
___ Partnership
___ Corporation
___ LLC
___ Other
You MUST attach a copy of the 2016 Federal Tax Extension form
1) Estimated Tax liability for year ended
(Minimum $40.00/Maximum $10,000)
$ ___________________
($___________________)
2) Less Credits/ Adjustments
$ ___________________
0.00
3) Subtotal (Subtract line 2 from line 1)
4) Penalty (Minimum is $25.00 or 5% per month not to exceed 25%)
$ ___________________
$ ___________________
5) Interest (1% per month)
6) Total amount due (add lines 3 through 5)
$ _________________
0.00
This form is to be used to apply for a six month extension of time to file the City of Florence
Annual Renewal – Occupational License Return. All estimated taxes due MUST be paid at the
time the extension is filed. For all taxes unpaid at the time the annual renewal is filed, penalty
and interest will be applied. Any fraction of a month will be counted as an entire month.
A business may file the City of Florence annual renewal return at any time before the extension
th
th
expires. The return will be due the 15
day of the 10
month following the close of the taxable
year end providing the extension has been granted.
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