| PLEASE RETURN COMPLETED COPIES OF THIS FORM WITH PAYMENT | ||||||||||
| EMPLOYERS PAYROLL TAX RETURN | 140 West Electric Ave. | |||||||||
| FLEMINGSBURG OCCUPATIONAL | P.O. Box 406 | |||||||||
| LICENSE FEE | Flemingsburg, KY 41041 | |||||||||
| Phone: (606) 845-5951 | ||||||||||
| Fax: (606) 845-0712 | ||||||||||
| Name: | Filing Status | |||||||||
| Federal ID: | ||||||||||
| DBA: | Monthly | Quarterly | Yearly | |||||||
| PLEASE INDICATE AT RIGHT THE FILING | Monthly Period Ended: | |||||||||
| STATUS AND WITHHOLDING PERIOD | ||||||||||
| Quarterly Period Ended: | ||||||||||
| Computer program will not update your account | ||||||||||
| without this information | Yearly Period Ended: | |||||||||
| All organizations are required to submit 1% from gross wages paid employees for service within the City of Flemingsburg. | ||||||||||
| If the Flemingsburg payroll tax due is under $100 per month, your filing status is "quarterly". For quarterly filers, payment | ||||||||||
| and this return are due on the last day of the month following the end of a quarter which is a period of three calendar months | ||||||||||
| ended on March 31, June 30, September 30, and December 31. If Flemingsburg payroll tax due is over $100 per month, | ||||||||||
| your filing status is "monthly". As a monthly filer, payment and this return are due by the fifteenth day following the end of the | ||||||||||
| first and second month of each quarter; the third month of each quarter, payment and this return are due by the last day of | ||||||||||
| the following month. | ||||||||||
| To change "Filing Status" from a monthly to a quarterly payroll tax filer or from a quarterly to a monthly filer, a written | ||||||||||
| request must be made to the License Fee Administrator. Change of filing status cannot be made until request is approved. | ||||||||||
| INSTRUCTIONS | ||||||||||
| Line 1: enter total compensation paid during this quarter/month regardless of when or where earned. | ||||||||||
| Line 2: enter the amount included in line 1 which represents payment for services performed or work done outside | ||||||||||
| Flemingsburg. The employer must maintain adequate records to substantiate this amount. | ||||||||||
| Line 5: A penalty of 10% is imposed after the due date of the return during which the license fee remains unpaid. | ||||||||||
| Line 6: Interest accrues at a rate of 1% on unpaid license fees from the due date of the return until paid. | ||||||||||
| WORKSHEET | ||||||||||
| 1. Total salaries, wages, commissions, and other compensation . | ||||||||||
| 2. Amount included in line 1 paid for services outside Flemingsburg | ||||||||||
| 3. Compensation subject to Flemingsburg Payroll Tax (line 1 minus line 2) .. | ||||||||||
| 4. Flemingsburg Payroll Tax Due (1% of line 3) .. | ||||||||||
| 5. Penalty (see instructions) | ||||||||||
| 6. Interest (see instructions) | ||||||||||
| 7. Total amount due (sum of lines 4,5, and 6) . | ||||||||||
| Make Check Payable to: City of Flemingsburg | ||||||||||
| I hereby certify that the statements herein and in any copies of supporting documents are true, correct and complete | ||||||||||
| subject to any and all applicable fines and penalties. | ||||||||||
| Signature | Title | Date | ||||||||