Form Cc1 - Federal Employee Occupational Tax Return - 2011
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1
2CC1REV1111
CAMPBELL COUNTY & CITIES, KENTUCKY
2011 FEDERAL EMPLOYEE
OCCUPATIONAL TAX RETURN
(See Instructions On Reverse Side)
C1 2011 12
YEAR ENDING: DECEMBER 31, 2011
DUE DATE: FEBRUARY 28, 2012
Name ____________________________
PRINT CAMPBELL CO. TAX ACCOUNT NUMBER:
Address __________________________
PRINT SOCIAL SECURITY NUMBER:
City _____________ State___ Zip______
CHECK BOX IF YOU WILL NOT WORK IN CAMPBELL COUNTY OR
CITIES IN 2012. ENTER LAST DATE OF EMPLOYMENT IN
CAMPBELL COUNTY OR CITIES.
COLUMN 1
COLUMN 2
COLUMN 3
COLUMN 4
COLUMN 5
COLUMN 6
COLUMN 7
COUNTY AND
TOTAL
TAXABLE
MAXIMUM
FEE
TAX RATE
WAGE LIMIT
CITY
EARNINGS
EARNINGS
FEE DUE
DUE
Campbell
0.0105
$38,667.00
$406.00
County
No Wage
No
Ft. Thomas
0.0125
„Cap‟
Maximum
Alexandria
0.0150
$106,800.00
$1,602.00
0.0100
$106,800.00
$1,068.00
Cold Spring
No Wage
No
Southgate
0.0250
„Cap‟
Maximum
Highland
0.0100
$100,000.00
$1000
Heights
8(a)
TOTAL FEE DUE
I DECLARE UNDER PENALTY OF PERJURY THAT I HAVE
EXAMINED THIS RETURN AND TO THE BEST OF MY
8 (b)
PENALTY
KNOWLEDGE AND BELIEF IT IS A TRUE, CORRECT AND
5% PER MONTH OR PORTION THEREOF
NOT TO EXCEED 25% (Minimum $25)
COMPLETE RETURN.
8 (c)
INTEREST
1% PER MONTH OR PORTION THEREOF
---------------------------------------------------------------------------------------------------
8 (d)
TOTAL DUE
SIGNATURE
DATE
IMPORTANT! DID YOU REMEMBER?
ATTACH A COPY OF YOUR W-2?
SIGN THIS FORM?
ENCLOSE CHECK OR MONEY ORDER, MADE PAYABLE
TO “CAMPBELL COUNTY FISCAL COURT”?
MAIL WITH W-2 COPY TO: Campbell County Fiscal Court, PO Box 72958, Newport, KY 41072-0958
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