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FORM W-
LOUISVILLE METRO REVENUE COMMISSION
KIRA
QUARTERLY WITHHOLDING TAX RETURN FOR EMPLOYERS
CLAIMING THE KENTUCKY INDUSTRIAL REVITALIZATION ACT CREDIT
CHECK IF CHANGE IN ADDRESS IS BELOW
Name
__________________________________________________________________________________
Address
__________________________________________________________________________________
City
_________________________________
State __________
Zip _______________
Federal ID _________________________________
Phone
Ext
____________________
_________________
If no employees this quarter, but future employee activity possible, check here
ACCOUNT NUMBER:
and sign the return below. (Lines 1 through 13 do not need to be completed.)
Permanently ceased having employees on _______________________________
FOR QUARTER ENDING:
Ceased all business activity on _________________________________________
DUE ON OR BEFORE:
QUARTERLY WAGES
TAX DUE
1. TOTAL GROSS WAGES EARNED BY EMPLOYEES
$
X 1.45%
=
$
WITHIN THE BOUNDARIES OF LOUISVILLE METRO, KY
2. TOTAL GROSS LOUISVILLE METRO, KY, WAGES
$
EARNED BY NON-RESIDENT EMPLOYEES
3. TOTAL GROSS LOUISVILLE METRO, KY, WAGES
$
$
=
X .75%
EARNED BY RESIDENT EMPLOYEES (LINE 1 – LINE 2)
4. KENTUCKY INDUSTRIAL REVITALIZATION ACT CREDIT
X _______%
$
$
=
FOR WAGES EARNED IN LOUISVILLE METRO, KY
Enter applicable rate
5. TOTAL TAX DUE
$
RECONCILIATION
(Line 1 + Line 3 – Line 4)
This section should be completed by only those employers who are
required to make monthly deposits. This applies to employers who paid
6. PENALTY & INTEREST
$
license fees totaling more than $3,000.00 during
any one of the preceding
Figures on Lines 8A-8C must reflect the
four (4) calendar quarters.
7. TOTAL AMOUNT DUE
amount that should have been paid for each month and should be equal
(Line 5 + Line 6)
to the Total Tax Due (Line 5).
$
(8.) A
(8.) B
(8.) C
9. TOTAL DEPOSITS PAID
$
FOR THE QUARTER
ST
ND
RD
AMOUNT DUE 1
MONTH
AMOUNT DUE 2
MONTH
AMOUNT DUE 3
MONTH
10. ADDITIONAL PAYMENT DUE
$
(If Line 7 > Line 9)
11. OVERPAYMENT TO BE
$
CREDITED TO NEXT QUARTER
12. OVERPAYMENT TO BE
$
REFUNDED
13. ACH CREDIT TRACKING NUMBER
(IF APPLICABLE)
This is to certify that the information shown on this return is true and correct to the best of my knowledge.
___________________________________________________________________
Title: ________________________
Authorized Signature
___________________________________________________________________
Date: ________________________
Print Name
MAILING ADDRESS: P.O. BOX 35410 • LOUISVILLE, KENTUCKY 40232-5410
Telephone: (502) 574-4860 • • Fax: (502) 574-4818 • • TDD: (502) 574-4811