Reconciliation Of Clark County Occupational Tax Withheld Form

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Reconciliation of Clark County Occupational Tax Withheld
Reconciliation for Year _____
Tax Administrator: Cheryl Wills
Current Contact Information
Year ____ Totals
Account Number
Active Date
Total Number of employees as listed hereon
Year ____ License Tax withheld…………….$
Account Name
Occupational Tax Withheld
____ first quarter tax withheld………………..$
Address
____ second quarter tax withheld……………$
____ third quarter tax withheld………………$
City/State/Zip
____ forth quarter tax withheld………………$
Phone
EMPLOYEE BREAKDOWN
PLEASE TYPE OR PRINT IN DARK COLORED INK
EMPLOYEE NAME
SOCIAL SECURITY NUMBER
Gross Wages Paid
Occupational Tax
Withheld
If report is complete on this page, total here……….
Direct all questions or comments to: Cheryl Wills, Occupational Tax Administrator.
(859)745-0202
Return to:
Clark County Fiscal Court Winchester, KY 40391

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