·
Reconciliation of Clark County Occupational Tax Withheld
Total number of employees as listed hereon
-
-, I-~
•••.
___
•
Account
Number
Active
Date
Year 2008 License Tax withheld ................... $
Occupational
Tax Withheld
Account Name
$
2008 first quarter
tax
withheld .......................
Address
$
2008 second quarter
tax
withheld
.................
City I
I
State
Zip
$
2008 third quarter tax withheld
......................
$
2008 forth quarter tax withheld
.....................
Phone
EMPLOYEE BREAKDOWN
PLEASE TYPE OR PRINT IN DARK COLORED
INK
Occupational
Tax
EMPLOYEE
NAME
SOCIAL SECURITY NUMBER
Gross Wages Paid
Withheld
If report
is complete
on this page, total here ...............
J.
Direct all questions or comments to:
Brenda
Mapel Occupational
Tax Administrator.
Return to:
Clark County Fiscal Court
Winchester,
KY 40391