City Of Winchester, Kentucky Return Of License Fee Page 2
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2Form DF-3 10/09
Mail Form to:
CITY OF WINCHESTER, KENTUCKY
Finance Department
City of Winchester
RECONCILIATION OF LICENSE FEE WITHHELD
P O Box 4135
Winchester, KY 40392
1793
During Year Ended __________
February 28,
To be filed by
or with Final Return upon completion of work or closing of a business.
How to Reconcile Your Payroll and Withholdings
Section 1 (Quarterly) or Section 2 (Monthly) -Under TOTAL PAYROLL enter the quarterly or monthly totals of all compensation
paid all employees. Deduct any payments for services performed outside Winchester and enter balance in SUBJECT PAYROLL
column. SUBJECT PAYROLL includes all compensation, i.e. Vacation and Holiday pay, tips and gratuities.
Attach a list of each subject employee, the Social Security Number, Name, Address, and Zip Code; total compensation paid and
amount of Winchester license fee withheld Or submit copies of W2 forms with an adding machine tape total of the license fee
withheld, or a computer generated report which provides the required information may also be submitted. Attach Form DF-3 with
Section 1 or Section 2 completed to the top of any W2’s or computer listings.
SECTION 1 (Quarterly)TOTAL PAYROLL SUBJECT PAYROLL
LICENSE FEE WITHHELD
ST
1. 1
Quarter ended March 31$__________________
$____________________ X 1.5% $__________________________
nd
2. 2
Quarter ended June 30 $__________________
$____________________ X 1.5% $__________________________
rd
3. 3
Quarter ended Sept 30
$__________________
$____________________ X 1.5% $__________________________
th
4. 4
Quarter ended Dec 31
$__________________
$____________________ X 1.5% $__________________________
5. TOTAL ALL QUARTERS $__________________
$____________________
$__________________________
6. Actual Withholdings Remitted for the year on Form DF
$__________________________
7. Difference between lines 5 and 6 (if any, check applicable block below)
$__________________________
____Minor difference attributable to fractional variations only (no adjustments due)
____Difference indicates insufficient total remittance for year. Check for payment attached.
____Difference indicates overpayment not attributable to fractional variations. FULL EXPLANATION AND CLAIM FOR
REFUND IS ATTACHED.
8. Number of Employees_________ __________________________________ _______________________ ____________
Signature
Title
Date
SECTION 2 (Monthly) TOTAL PAYROLL SUBJECT PAYROLL
LICENSE FEE WITHHELD
1. January
$__________________
$____________________ X 1.5% $__________________________
2. February
$__________________
$____________________ X 1.5% $__________________________
3. March
$__________________
$____________________ X 1.5% $__________________________
4. April
$__________________
$____________________ X 1.5% $__________________________
5. May
$__________________
$____________________ X 1.5% $__________________________
6. June
$__________________
$____________________ X 1.5% $__________________________
7. July
$__________________
$____________________ X 1.5% $__________________________
8. August
$__________________
$____________________ X 1.5% $__________________________
9. September
$__________________
$____________________ X 1.5% $__________________________
10.October
$__________________
$____________________ X 1.5% $__________________________
11.November
$__________________
$____________________ X 1.5% $__________________________
12.December
$__________________
$____________________ X 1.5% $__________________________
13. TOTAL ALL MONTHS $__________________
$____________________
$__________________________
14. Actual Withholdings Remitted for the year on Form DF
$__________________________
15. Difference between lines 5 and 6 (if any, check applicable block below)
$__________________________
____Minor difference attributable to fractional variations only (no adjustments due)
____Difference indicates insufficient total remittance for year. Check for payment attached.
____Difference indicates overpayment not attributable to fractional variations. FULL EXPLANATION AND CLAIM FOR
REFUND IS ATTACHED.
16. Number of Employees_________ __________________________________ _______________________ ____________
Signature
Title
Date
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