| BUSINESS LICENSE | 140 West Electric Ave. | |||||||||||
| STATUS CHANGE FORM | P.O. Box 406 | |||||||||||
| Flemingsburg, KY 41041 | ||||||||||||
| Phone: (606) 845-5951 | ||||||||||||
| Fax: (606) 845-0712 | ||||||||||||
| If any of the following is applicable to your | ||||||||||||
| Federal I.D.: | organization, please check the appropriate | |||||||||||
| DBA: | box below, complete the information | |||||||||||
| Street Address: | requested, sign this form, and return to the | |||||||||||
| City, State, Zip: | attention of the License Fee Administrator. | |||||||||||
| DO NOT ANTICIPATE WORKING IN FLEMINGSBURG | ||||||||||||
| As a business location located outside of Flemingsburg, I do not anticipate working in Flemingsburg. | ||||||||||||
| If I do get a job, I will notify the License Fee Administrator in order to activate my account. A | ||||||||||||
| Business License should be purchased before start of work. (A business located within the City of | ||||||||||||
| Flemingsburg must purchase a Business License whether working in Flemingsburg or not.) | ||||||||||||
| I understand I am responsible for filing the Net Profits License Fee Return by April 15, or within 105 | ||||||||||||
| days from the end of my fiscal period. | ||||||||||||
| NO LONGER IN BUSINESS | ||||||||||||
| I am no longer in business. Please enter the date you went out of business on the line below: | ||||||||||||
| ________________. I understand even though I am no longer in business I am still required to file | ||||||||||||
| the Net Profits License Fee Return for the period I was in business. (This return is due by April 15, or | ||||||||||||
| 105 days from the end of your fiscal period.) Please enter your forwarding address and phone number | ||||||||||||
| below and be sure to sign this letter: | ||||||||||||
| If business was sold or transferred please list name, address, and phone number of successor | ||||||||||||
| and attach to this form. | ||||||||||||
| CHANGE IN OWNERSHIP/LEGAL STRUCTURE | ||||||||||||
| If the legal structure of your business changes by merger, by a change in form of ownership, or by | ||||||||||||
| a change in Federal ID number (for example, a Sole Proprietor to an S-Corporation or to a | ||||||||||||
| Corporation) written notice of such change is required or this completed form may be submitted. | ||||||||||||
| The new owner must complete a new Business Application (Form 551), obtain a new City of | ||||||||||||
| Flemingsburg account number, and purchase a new Business License. Please contact the License | ||||||||||||
| Fee Administrator. Failure to purchase the Business License within thirty days of the change will | ||||||||||||
| result in an additional $25.00 penalty. | ||||||||||||
| CHANGE IN BUSINESS NAME, MAILING ADDRESS BUSINESS LOCATION, OR PHONE NUMBER | ||||||||||||
| New business name: | ||||||||||||
| New business location: | ||||||||||||
| New mailing address: | ||||||||||||
| New phone number: | ||||||||||||
| If your Federal ID Number changed, please contact the License Fee Administrator. A "CHANGE IN OWNERSHIP/ | ||||||||||||
| LEGAL STRUCTURE" requires completion of a Business Application (Form 551), a new City of Flemingsburg account | ||||||||||||
| number, and purchase of a new Business License. | ||||||||||||
| Signature | Title | Date | ||||||||||
