Form 1306 - Non-Employee Earnings Transmittal - Boone County Fiscal Court - 2012
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1Boone County Fiscal Court
2950 Washington Street
PO Box 960
Burlington, KY 41005
(859) 334-2144
(859) 334-3914 fax
Non-Employee Earnings Transmittal for 2012
Name:
Account #: ________________________________________
dba:
FEIN/SSN:_________________________________________
(please advise if incorrect)
Address:
For Year Ended: December 31, 2012
City, State, Zip:
Form Due Date: February 28, 2013
For Official Use Only
Date Keyed _____________
Initial___________________
Instructions:
Boone County, KY requires any entity engaged in a trade or business, including non-profit organizations, to disclose for each
calendar year non-employee payments of $600.00 or more made for services performed and/or rent paid within the county. Organizations
exempt from receiving 1099's due to their corporate structure should still be included in this report. The payer shall provide to
the county, by February 28th of the year following the payment, copies of the 1099's or a list of names, Social Security # and/or FEIN
(Federal ID Number), addresses and amounts paid to non employees for Boone County services and rent expense paid for property or equipment.
NOTE: Identify ONLY amounts paid for services performed fully or partially within the county. Information on payments made for services
provided entirely outside the county should NOT be included.
# of pages attached
Non-Employee Earnings within Boone
Name and Address of Non-Employee or Landlord (Rent Expense)
Social Security or FEIN
County Limits and Rent Paid
Rent
Services
Rent
Services
Rent
Services
Rent
Services
Rent
Services
Rent
Services
Rent
Services
Rent
Services
Attach Additional Sheet if Necessary
Signed:
Date:
Official Title:
Telephone Number:
Tax Form Prepared By:
I declare, under the penalties of perjury, that I have examined this document and to the best of my knowledge and belief, this is a true and accurate return.
Please notify in writing any changes of ownership or new address by completing a Request to Change/Close Occupational License Account which
can be found on our website @ If you have any questions please call 859-334-2144 or email:
Form 1306
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