Form Ol-3e - Extension Request - Louisville Metro Revenue Commission
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1LOUISVILLE/JEFFERSON COUNTY
FORM
3
METRO REVENUE COMMISSION
OL-
E
EXTENSION REQUEST AND/OR ESTIMATED PAYMENT
CHECK IF CHANGED
Name
________________________________________________________________________________
Address
________________________________________________________________________________
City
___________________________________
State _________
Zip _____________
__________
Phone
__________________________
Ext
ACCOUNT NO
TAX YEAR ENDING
Each individual taxpayer or business entity registered with this agency for the purpose of reporting local occupational taxes must apply
separately to this agency for an extension of time within which to file their local tax return. This application must be submitted by the 15th day
of the fourth month following the close of the tax year.
Individual Social Security Number ______________________________
Federal ID Number, if applicable _______________________________
An estimated payment of $____________________ is enclosed.
INTEREST
- Full payment of tax due must be paid by the original due date of the return to avoid interest charges of 12% annually. Interest
is assessed from the regular due date of the return until the tax due is fully paid.
PENALTIES
- Unless estimated payments equal to at least 90% of the final tax liability are made by the regular due date of the return, a late
payment penalty of 1% per month (to a maximum of 5% cumulative) of the unpaid amount as finally determined will be assessed.
NOTICE - CORPORATIONS AND PARTNERSHIPS:
If this extension request is for a tax period of less than twelve (12) months,
please indicate the reason below.
[
] Tax year end changed to: ______/______/______.
[
] Final return -- Business ceased ______/______/______.
[
] Corporate Merger -- Short year return due to merger on ______/______/______ with:
Name and address:
Federal ID:
After this short year return, our tax year will end on ______/______/______.
[
] Corporate Acquisition -- Short year return due to the acquisition on ______/______/______ by:
Name and address:
Federal ID:
After this short year return, our tax year will end on ______/______/______.
[
] Other:
(Please explain.)
Signature of Preparer
Print Name
Phone Number
MAILING ADDRESS: P.O. BOX 35410 • LOUISVILLE, KENTUCKY 40232-5410
Telephone: (502) 574-4860 •
• Fax: (502) 574-4818 • • TDD: (502) 574-4811
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