Occupational License Tax Withholding Application Form - City Of Calvert City printable pdf download

CITY OF CALVERT CITY

OCCUPATIONAL LICENSE TAX WITHHOLDING APPLICATION

Return to:

City of Calvert City, Tax Administrator, PO Box 36, Calvert City, KY 42029

Phone: 270-395-7138 Fax: 270-395-5554

This form is to be filled out and submitted to the above address by all businesses having employees within the

city limits of Calvert City, Kentucky and shall be used as a basis for issuance of a withholding account

identification number.

1. Business Name: __________________________________________Fed ID #:____________________________

2. Business Address: ____________________________________________________________________________

______________________________________________ Phone No. _________________ Fax ________________

3. E-Mail Address: ______________________________________________________________________________

4. Mail Address, if different from above: ____________________________________________________________

______________________________________________ Phone No. _________________ Fax _________________

5. Type of ownership: ( ) Individual; ( ) Partnership; ( ) Corporation; ( ) Non Profit; ( ) Other___________________

6. If individual, list name, address, and social security number of owner ____________________________________

____________________________________________________________ Soc. Sec. No. ______________________

7. If partnership, list name, address, and social security number of each partner

____________________________________________________________ Soc. Sec. No. ______________________

8. Nature of business: ___________________________________________________________________________

9. Do you have, or will you have, employees working in Calvert City? ( ) Yes ( ) No

10. Date that business first paid, or will pay, wages to employees in Calvert City: ____________________________

11. Name of previous owner of this business, if any: ___________________________________________________

12.Date you assumed ownership: __________________________________________________________________

13. Accounting period: ( ) Calendar year – Dec. 31, or ( ) Fiscal year ended _____________/______________

Month

Day

14. Other Information: __________________________________________________________________________

_____________________________________________________________________________________________

I hereby certify that all information and statements herein are true and correct.

_______________________________________/ ______________________________/ ______________________

Signature

Title

Date

_____________________________________________________________________________________________

FOR OFFICE USE ONLY

Identification No. _________________

Date account established: ________ Identification # reassigned from:_____________________

Date account closed: ___________ Identification # assigned to:_________________________

Date reassigned: ________________________________________________________________

Occupational License Tax Withholding Application Form - City Of Calvert City