Form Ol-3ez - Occupational License Fees Return
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1FORM
LOUISVILLE/JEFFERSON COUNTY
3
OL-
EZ
METRO REVENUE COMMISSION
OCCUPATIONAL LICENSE FEES RETURN
** REVISED FORM DUE TO MERGER OF CITY OF LOUISVILLE AND JEFFERSON COUNTY, KENTUCKY **
CHECK IF CHANGED
ACCOUNT NUMBER
Name
_____________________________________________________________________________
Address
_____________________________________________________________________________
FOR YEAR ENDING
MM
DD
YY
City
____________________________________________
Zip _________
State ________
Federal ID
___________________________
Phone No.
Ext __
______________________
________
Date Operations Ceased: _____________ (Required to close account.)
CHECK IF “FINAL RETURN”
CHECK IF “NO ACTIVITY” FOR YEAR
Income or (Loss):
1. Amount of income per Form 1099-MISC or gross wages per Form W-2.
(Attach a copy of Form 1099-MISC, Form W-2, or page 1 of Form 1040.)
1.) $_____________
Tax Computation:
Do you live in Louisville Metro, Kentucky? If “yes”, complete Section A only. If “no”, complete Section B only.
Section A. Residents of Louisville Metro, Kentucky:
2. Amount of income per Line 1
2.) $_____________
3. Tax Due (Multiply Line 1, Section A, by 2.2%)
3.) $_____________
4. Penalty and Interest
4.) $_____________
5. Amount to be paid (Line 3 + Line 4)
5.) $_____________
Section B. Non-residents of Louisville Metro, Kentucky:
2. Amount of income per Line 1
2.) $_____________
3. Tax Due (Multiply Line 2, Section B, by 1.45%)
3.) $_____________
4. Penalty and Interest
4.) $_____________
5. Amount to be paid (Line 3 + Line 4)
5.) $_____________
I hereby certify, under penalty of perjury, that the information herein and in any supporting schedules is true, correct, and complete
to the best of my knowledge.
/
/
/
/
Preparer’s Signature (Return must be signed.)
Date
Signature of Licensee (Return must be signed.)
Date
Print Name
Federal ID
Print Name
Title
Address
Phone No.
Social Security Number
ATTENTION: Federal ID Numbers and Social Security Numbers must be supplied for both the Tax Preparer and the Licensee.
Mail Form OL-3A, along with a copy of the federal Schedule C, and check or money order with your account number. The return
th
and payment of taxes due must be received by April 15
to avoid penalties and interest.
MAILING ADDRESS: P.O. BOX 35410 • LOUISVILLE, KENTUCKY 40232-5410
Telephone: (502) 574-4860 •
• Fax: (502) 574-4818 • • TDD: (502) 574-4811
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Parent category: Financial