City Of Winchester, Kentucky Return Of License Fee
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1
2Mail Form to:
Finance Department
CITY OF WINCHESTER, KENTUCKY
City of Winchester
RETURN OF LICENSE FEE
P O Box 4135
1793
Winchester, KY 40392
1. Total Earnings Paid All Employees
$____________________
BUSINESS NAME AND ADDRESS:
2. Deduct Earnings For Service Performed
Outside Winchester, Kentucky
$____________________
3. Earnings Subject to License Fee
$____________________
4. Actual Fee withheld at 1.5%
$____________________
5. Delinquent Penalty 5% Per Month
(Max 25%) Minimum $25.00
$____________________
6. Interest 1% Per Month
$____________________
Check One:
7. TOTAL
$____________________
_____Quarter _____Month ______Annual
I, declare, under the penalties of perjury, that this return has been
Time Period of Return _______________
examined by me and to the best of my knowledge and belief is a true,
Due Date__________________________
correct, and complete return.
____________________ _______________________________________________________
_____________________
DATE
SIGNATURE
TITLE
DF3 10/09
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Mail Form to:
Finance Department
CITY OF WINCHESTER, KENTUCKY
City of Winchester
RETURN OF LICENSE FEE
P O Box 4135
1793
Winchester, KY 40392
1. Total Earnings Paid All Employees
$____________________
BUSINESS NAME AND ADDRESS:
2. Deduct Earnings For Service Performed
Outside Winchester, Kentucky
$____________________
3. Earnings Subject to License Fee
$____________________
4. Actual Fee withheld at 1.5%
$____________________
5. Delinquent Penalty 5% Per Month
(Max 25%) Minimum $25.00
$____________________
6. Interest 1% Per Month
$____________________
Check One:
7. TOTAL
$____________________
_____Quarter _____Month ______Annual
I, declare, under the penalties of perjury, that this return has been
Time Period of Return _______________
examined by me and to the best of my knowledge and belief is a true,
Due Date__________________________
correct, and complete return.
____________________ _______________________________________________________
_____________________
DATE
SIGNATURE
TITLE
DF3 10/09
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Mail Form to:
Finance Department
CITY OF WINCHESTER, KENTUCKY
City of Winchester
RETURN OF LICENSE FEE
P O Box 4135
1793
Winchester, KY 40392
1. Total Earnings Paid All Employees
$____________________
BUSINESS NAME AND ADDRESS:
2. Deduct Earnings For Service Performed
Outside Winchester, Kentucky
$____________________
3. Earnings Subject to License Fee
$____________________
4. Actual Fee withheld at 1.5%
$____________________
5. Delinquent Penalty 5% Per Month
(Max 25%) Minimum $25.00
$____________________
6. Interest 1% Per Month
$____________________
Check One:
7. TOTAL
$____________________
_____Quarter _____Month ______Annual
I, declare, under the penalties of perjury, that this return has been
Time Period of Return _______________
examined by me and to the best of my knowledge and belief is a true,
Due Date__________________________
correct, and complete return.
____________________ _______________________________________________________
_____________________
DATE
SIGNATURE
TITLE
DF3 10/09
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