Form 3406 - Governmental Employee Tax Return For 2009 printable pdf download

Form 3406 - Governmental Employee Tax Return For 2009

Boone County Fiscal Court

2950 Washington Street

PO Box 960

Burlington, KY 41005

(859) 334-2144

(859) 334-3914 fax

Governmental Employee Tax Return for 2009

Name:

Account #: ________________________________________

Address:

Social Security #: __________________________________

(please advise if incorrect)

City, State, Zip:

For: The Calendar Year 2009

Due Date: on/before April 15, 2010

Attach Copy of W-2 to this return

Total Gross Earnings of Individual Working in Boone County

Boone County Board of Education Tax - 1/2 of 1% (.005)

*****No Maximum*****

1) Gross earnings subject to Boone County Board of Education tax

2) Multiply Line 1 - by 1/2 of 1% (.005)

3) Total Board of Education Tax

Boone County Ordinance #430-1A - 8/10 of 1% (.008)

*****Max $54,128.00/tax of $433.02*****

4) Gross earnings subject to Boone County payroll tax

5) Multiply Line 4 - by 8/10 of 1% (.008)

6) Total Boone County Payroll Tax

Boone County Mental Health Tax - 15/100 of 1% (.0015)

*****Max $16,666.00/tax of $25.00*****

7) Gross earnings subject to Mental Health Payroll tax

8) Multiply Line 7 by 15/100 of 1% (.0015)

9) Total Mental Health Tax

10) TOTAL PAYROLL TAX LIABILITY(lines 3+6+9)

11) Total Taxes withheld (From W2)

12) Total estimated taxes Paid

13) TOTAL TAXES PAID (Lines 11 + 12)

14) TOTAL REMITTANCE DUE ( Line 10 less Line 13)

Signed:

Date:

Printed Name:

Telephone Number:

E-Mail

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

Make Your check Payable to Boone County Fiscal Court

and mail to:

Form 3406

PO Box 457, Florence, KY 41022-0457