Form 01 - Employers Return Of License Fee Withheld - State Of Kentucky

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MCPT
-
FORM
01
MERCER COUNTY KENTUCKY
Federal ID Number
Account Number
EMPLOYERS RETURN OF LICENSE FEE WITHHELD
*If No Wages Were Paid This Period, Mark None And Return This Form
Licensee
1. Total Earnings Paid All Employees
$
2. Earnings for Services
Outside Mercer County
$
.
3. Earnings Subject to
License Fee
$
4. Actual Fee Withheld
@ .45% (.0045)
$
Please correct any error in ownership, name and address
5. If late, penalty is 5.00% of line 4 compounded per
calendar month (Note: a fraction of a month is counted
as a whole month) with a minimum of $25.00 and
maximum of 25.00% of tax due
$
6. 12.00% interest per annum
$
7. Balance Due (Items 4 & 5 &6)
$
I hereby certify that the information, statements, schedules
and exhibits filed herewith are true and accurate.
Signed
Date
Official Title
For Quarter:
Quarter
Y
Make Payment to:
Mercer County
Fiscal Court
Return Due Dates:
Qtr.
I :
April
30
Mail Payment To:
Qtr.
2:
July
31
Mercer County Tax Administrator
Qtr.
3:
October 31
134
S Main Street
Qtr.
4:
January
31
Harrodsburg,
KY 40330
(859) 734-6300
Keep One Copy For Your Records and Retum One Copy With Your Payment

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