Form Cc-3 - Campbell County & Cities Occupational Tax & Business License Fee Annual Return - 2016

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CAMPBELL COUNTY & CITIES OCCUPATIONAL TAX & BUSINESS LICENSE FEE ANNUAL RETURN
(No Substitute Forms—See Instructions)
Form CC-3
CC-3 2016
TAX YEAR ENDING:
DUE DATE:
Rev. 1116
Print Date ______________
Print Date ______________
FEDERAL TAX ID# OR SOCIAL
Page 1
ACCOUNT ID #:
SECURITY NUMBER:
Please print
Print __________________ Print __________________
Business name: ____________________________________
Check if new address
and make corrections
Address:
____________________________________
Address:
____________________________________
TAX OFFICE USE ONLY
UNDERPAID ___ APP ___ 1099’S ___ FED SUPPORT ___
City/State/Zip: _____________________________________
PAYROLL ___ OTHER ___ NOTICE # ________________
FINAL RETURN (Check ONLY to CLOSE ACCOUNT):
DATE OPERATIONS CEASED OR BUSINESS SOLD: ________________________________
WAS THERE A CHANGE OF OWNERSHIP/ENTITY? ____ YES ____NO
PRINT NAME & ADDRESS OF NEW BUSINESS OWNER/ENTITY:
_____________________________________________________________________________
_____ YES _____ NO
Did you make payments in the sum of $600.00 or more to any individual for services rendered in Campbell County or
City other than an employee? IF YES, YOU ARE REQUIRED TO FILE FORM 1099-MISC WITH THIS RETURN.
COLUMN 1
Col. 2
Col. 3
Col. 4
Col. 5
TAX/FEE LIMITS
Col. 6
Col. 7
Col. 8
Col. 9
LOCALITY
TAX/FEE
SUBJECT
RATE
TAX
MINIMUM
MAXIMUM
TAX
ESTIMATED
2016
2017
(Taxpayers must
TYPE
EARNINGS
AMOUNT
TAX
TAX
DUE
PAYMENT
TOTAL
MINIMUM
file to County
(Includes
TAX
RENEWAL
AND to applicable
Prior Year
DUE
FEE/TAX
cities)
Column 9)
CAMPBELL
NET
.0105
$25.00
$610.00
$25.00
COUNTY
$25.00
NO LIMIT
FORT THOMAS
NET
.0125
$25.00
ALEXANDRIA
FEE
$75 FLAT FEE
$100.00
New in 2017
COLD SPRING
GROSS
TABLE
$25.00
$1,500.00
$25.00
SOUTHGATE
GROSS
TABLE
$35.00
$5,500.00
$35.00
HIGHLAND
GROSS
.0035
$75.00
$10,000.00
$75.00
HEIGHTS
MELBOURNE
FEE
$50 FLAT FEE
$50.00
WOODLAWN
FEE
$50 FLAT FEE
$50.00
RETURN MUST BE SIGNED—I hereby certify, under penalty of perjury, that the information
TOTAL 8a.
9.
herein and in any supporting schedules is true, correct and complete to the best of my
0
knowledge.
_____________________________________
_____________________________________
TOTAL (Box 8a. plus Box 9)
10.
0
LICENSEE’S SIGNATURE
DATE
PRINTED NAME
TITLE
PENALTY (5% per month or portion thereof
________________________________
________________________________
not to exceed 25%. Minimum $25) 11.
PREPARER’S SIGNATURE
DATE
PRINTED NAME
INTEREST (1% per month or portion
___________________________________________________________________
thereof) 12.
PREPARER ADDRESS
PHONE NO.
SOCIAL SEC. # OR FED. TAX ID.
0
TOTAL AMOUNT DUE 13.
ATTENTION: Federal ID Numbers and Social Security Numbers must be
(check here if REFUND due ____)
Supplied for both Tax Preparer and Licensee.
_____________
CHECK NUMBER

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