Annual Renewal - Occupational License - City Of Florence - 2017
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1CITY OF FLORENCE, KENTUCKY
2017 ANNUAL RENEWAL – OCCUPATIONAL LICENSE
th
th
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, Kentucky
Classification:
Remit form to:
P.O. Box 1327
___ Individual
Florence, Kentucky 41022-1327
___ Partnership
___ Corporation
___ LLC
See reverse side for instructions
___ Other
COPY OF DOCUMENTATION MUST ACCOMPANY THIS RETURN. SEE REVERSE SIDE FOR LIST OF
ACCEPTABLE DOCUMENTATION.
* Instructions for the below can be found on the reverse side.
Round to nearest $
1. Total gross receipts as defined per instructions on reverse side
$
2. Allocation percentage from Schedule A or 100% if all receipts
were earned in the City of Florence
%
3. Gross receipts derived in City ( multiply Line 1 times Line 2)
$
0.00
4. Amount of tax due – (Minimum $40/Maximum $10,000)
$
40.00
5. Game machine tax
$
0.00
6. Duplicate fee
$
0.00
7. Adjustment
$
0.00
8. Sub-total (Add Lines 4 thru 7)
$
40.00
9. Penalty (5% per month not to exceed 25%; however Minimum is $25.00)
$
10. Interest (1% per month)
$
11. Total amount due (Add Lines 8 thru 10)
$
40.00
Any business entity claiming a deduction for gross receipts outside of the City MUST complete
Schedule A - Computation of Business Apportionment.
Did you have any employees during calendar 2016?
Y or
N
Did you rent or lease real estate property during 2016? Y or N
If yes, Landlord Name & Address:_____________________________________________________________________________
Did you issue any 1099 forms during 2016 for work performed in Florence?
Y
or
N
If yes, please provide a copy of the 1099 forms that were issued.
Is this return your FINAL RETURN (indicating Y will close your account)?
Y or N
Signed:
________________________________________________________
Official Title: _______________________
Print name: ________________________________________________________
Date:
_______________________
I DECLARE, UNDER THE PENALTIES OF PERJURY THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST OF
MY KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE RETURN. I AM DULY AUTHORIZED TO SIGN THIS
RETURN.
OCCUPATIONAL LICENSE RETURNS WITHOUT DOCUMENTATION WILL NOT BE RENEWED.
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