Compensation Tax Return Form - City Of La Grange Kentucky

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CITY OF LA GRANGE
307 W. Jefferson St.
La Grange, KY 40031
Phone: (502) 222-1433
Fax: (502) 222-5875
William
Kevin L. Collett
Lammlein
Chief of Police
Mayor
COMPENSATION TAX RETURN
Due the last day of the month following the close of each taxable quarter end
This form must be completed and returned to the city, even if no taxes are due
Business name: ___________________________________Tax Quarter ended: _____________________
Address: ________________________________________ Due date: _____________________________
City/State/Zip: ___________________________________ Federal ID/SS #: ________________________
Account #: ____________________________________
Phone #: ______________________________
Business Entity
Classification:
Make payable to:
City of La Grange
___ Individual
Remit form to:
307 W Jefferson St.
___ Partnership
La Grange, Kentucky 40031-8682
___ Corporation
___ LLC
___ Other
See page 2 for detailed instructions
Round to nearest $
* Instructions for the below can be found on page 2.
1. Total / GROSS compensation paid in City (including Annual Leave,
$
Vacation, Sick and Holiday Pay)
2. Amount of tax/ Withholdings due (line 1 multiplied by .01)
$
3. Game machine tax ($10 per machine)
$
4. Occupations fee (set fee’s for Carnivals, Circuses, Door to Door Sales,
$
Nurserymen, Farm Workers, Itinerant, Peddlers, Taxicabs & Limousines)
5. Sub-total (Add Lines 2 through 4)
$
6. Penalty (Minimum is $25.00 or 5% per month not to exceed 25%)
$
7. Interest (12% per annum, simple)
$
8. TOTAL amount due (Add Lines 5 through 7)
$
I DECLARE, UNDER THE PENALTIES OF PERJURY THAT THIS RETURN HAS BEEN EXAMINED BY ME AND TO THE BEST
OF MY KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE RETURN. I HAVE DOCUMENTATION TO
SUPPORT THE AMOUNTS STATED HEREIN. I AM DULY AUTHORIZED TO SIGN THIS RETURN.
Signed:
_________________________________
Official Title: ____________________________
Print name: _________________________________
Date:
_____________________________
INCOMPLETE FORMS ARE VOID
Revised 2-19-2014

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