Kenton County Form ACC1 – Fill Out and Use This PDF

Page 1 INCLUDE ALL APPLICABLE FEDERAL FORMS, SCHEDULES AND STATEMENTS WITH RETURN

FOR OFFICE USE ONLY

Annual Occupational Fee & Business License Renewal Return

1099

ADJ

ADT

ALL

CT1A

LPS

LOJ

Kenton County and Cities', Kentucky

Form ACC1 REV 01/2013

• LICENSEE, NOT PREPARER, RESPONSIBLE

OV

PI

PRF

RAE

RF

TERM

UN

FOR ALL INFORMATION AND PAYMENTS.

MANDATORY - MUST PROVIDE

• DOWNLOAD INSTRUCTIONS, SCHEDULE N & G

• DO NOT STAPLE THIS FORM OR ATTACHMENT

ACCOUNT NUMBER

YEAR

FISCAL END

CURRENT LICENSE

DUE DATE

EXPIRES

Check if new address: DBA, Name & Mailing Address.

MONTH

DATE

FEDERAL I.D. OR SOCIAL SECURITY NO

FED. BUS. ACTIVITY CODE

FINAL RETURN (Check ONLY to CLOSE ACCOUNT):

PROVIDE ANY CHANGE OF INFORMATION HERE

DATE OPERATIONS CEASED OR BUSINESS SOLD:

WAS THERE A CHANGE OF OWNERSHIP/ENTITY? NO

YES

PRINT NAME & ADDRESS OF ENTITY ON CHANGE OF INFO SECTION

Business Name

EXTENSION REQUEST AND EXTENSION FILING INSTRUCTION

• FOR A SIX (6) MONTH EXTENSION, MAKE A COPY OF THIS FORM AND PAY AT

Business Owner

LEAST 90% OF ANY ESTIMATED FEES DUE AND ALL LICENSE RENEWALS

• ALLOCATE ALL ESTIMATED PAYMENTS TO EACH CITY OR COUNTY

Address

• TAXPAYER MUST FILE TO COUNTY AND TO APPLICABLE CITIES BELOW

Actual Return. Check this box, if an extension or superseding return was filed

City, State, ZIP

or estimated payments were applied. Enter each amount paid in column 7.

COLUMN 1

COL 2

COLUMN 3

COL4

COLUMN 5

COLUMN 6

COLUMN 7

COLUMN 8

COLUMN 9

COLUMN 10

CITY OR

FEE

SUBJECT

RATE

FEE LIMITS

FEE

TOTAL

BUSINESS LICENSE

PENALTY

COUNTY

TYPE

EARNINGS

DUE

PAYMENT

FEE DUE

FOR TAX YEAR

MINIMU

MAXIMU

KENTON COUNTY

NET

0

$0 TO $37,500

KENTON COUNTY

NET

0

******

$37,501 TO FICA CAP

BROMLEY

GROSS

COVINGTON

NET

********** File Covington Net Profit Tax Directly With City of Covington **********

CRESCENT SPRINGS

GROSS

CRESTVIEW HILLS

NET

EDGEWOOD

NET

ELSMERE

NET

ERLANGER

GROSS

FORT MITCHELL

GROSS

FORT WRIGHT

GROSS

INDEPENDENCE

GROSS

LAKESIDE PARK

GROSS

LUDLOW

NONE

PARK HILLS

GROSS

TAYLOR MILL

NET

VILLA HILLS

GROSS

RETURN MUST BE SIGNED - I hereby certify under penalty of perjury, that the statements made herein and

TOTAL FEE DUE COLUMN 8

9a

in any supporting schedule are true, correct and complete to the best of my knowledge.

Total Column 9 or Countywide $225.

9b

If filed late, enter Total of column 9.

Total Line 9A +

Line 9B

9c

SIGNATURE OF LICENSEE

DATE

PHONE NUMBER

PENALTY

Total Column 10

9d

INTEREST Line 9c x 1% Per Month

9e

Not to Exceed 12% Per Year

PRINT NAME

TITLE

TOTAL

DUE(CREDIT) 9c+9d+9e

9f

Prior Year Credit or Carry Forward

9g (

)

SIGNATURE OF INDIVIDUAL PREPARING FORM

DATE

PHONE NUMBER

If Total of 9f and 9g is Greater than -0-

9h

Enter Amount Due

Remit to:

KENTON COUNTY

If Total of 9f and 9g is Less than -0-

9i

FISCALCOURT

Enter Overpayment

Note: Address changed

PO BOX 706237

Amount from Line 9i you want

9j

PRINT NAME

CINCINNATI

OH 45270

Credited

Refunded