Form Ol-3a - Occupational License Fees Return - Louisville/jefferson County Metro Revenue Commission
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1FORM
LOUISVILLE/JEFFERSON COUNTY
3
OL-
A
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 Net Profit per your federal Schedule C
(Attach a copy of Schedule C of Form 1040)
1.) $________________
2.
Add: Occupational taxes deducted on Schedule C
2.) $________________
3.
3.) $________________
Adjusted Net Profit (Line 1+ Line 2)
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:
4.
Adjusted Net Profit per Line 3 above
4.) $________________
5.
Tax Due (Multiply Line 4, Section A, by 2.2%)
5.) $________________
6.
Penalty and Interest
6.) $________________
7.
Amount to be paid (Line 5 + Line 6)
7.) $________________
Section B. Non-residents of Louisville Metro, Kentucky)
4.
Adjusted Net Profit per Line 3 above
4.) $________________
5.
Tax Due (Multiply Line 4, Section B, by 1.45%)
5.) $________________
6.
Penalty and Interest
6.) $________________
7.
Amount to be paid (Line 5 + Line 6)
7.) $________________
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.
/
/
/
/
Date
Date
Preparer’s Signature (Return must be signed.)
Signature of Licensee (Return must be signed.)
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 or postmarked 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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