Account Number
Federal ID or SSN
1. 1. X 2.25% = 1.
2. 2. X 2.25% = 2.
3. 3. X 2.25% = 3.
4. 4. X 2.25% = 4.
5. 5. X 2.25% = 5.
6. 6. X 2.25% = 6.
7. 7. X 2.25% = 7.
8. 8. X 2.25% = 8.
1. January
2. February
3. March or 1st Qtr.
4. April
5. May
6. June or 2nd Qtr.
7. July
8. August
9. September or 3rd Qtr. 9. 9. X 2.25% = 9.
10. 10. X 2.25% = 10.
11. 11. X 2.25% = 11.
12. 12. X 2.25% = 12.
10. October
11. November
12. December or 4th Qtr.
13. Total Year
13. $ 13. $ X 2.25% = 13. $
14. Actual License fee withheld per W-2s
14. $
15. Enter the larger of line 13 or line 14.
15. $
16. Actual License Fee remitted for the year on Form 220/221
16. $
17. Difference between lines 15 and 16 (if any, check applicable box below)
17. $
Minor difference attributable to fractional variations only (no adjustment due)
Difference indicates insufficient total remittance for year. Check in payment attached
Make Checks Payable to:
Difference indicates overpayment not attributable to fractional variations. Full explanation and L.F.U.C.G
claim for refund is attached. Division of Revenue
Lex-Fay Urban Co Govt
P.O. Box 14058
Lexington KY 40512
18. For each of the following benefits.
Yes
No
Yes
No
a) Deferred compensation
b) Cafeteria plan
c) Group-term life insurance over $50,000
d) Other?
e) Other?
f) Other?
Number of Employees:
Date
Form 222/ 17RCF Revised 1/2018
Signature Title
LEXINGTON-FAYETTE URBAN COUNTY GOVERNMENT
2017 RECONCILIATION OF LICENSE FEE WITHHELD
USE REVERSE SIDE FOR EMPLOYEE LISTING
Enter on reverse side for each subject employee the Social Security no., name,
address and zip code, total compensation paid (before the deduction of any
pre-taxed items) and amount of Fayette County license fee withheld. Attach
additional sheets of this size if space requirements are inadequate. Employers
may opt to submit copies of W2 forms or other type of listings which provide
the required information.
TOTAL PAYROLL SUBJECT PAYROLL LICENSE FEE DUE
Did your employees
participate in?
Was the license fee
withheld?
During year ended December 31, 2017
To be filed by February 28, 2018
HOW TO RECONCILE YOUR PAYROLL AND WITHHOLDINGS
PLEASE NOTIFY THIS OFFICE OF ANY CHANGE IN OWNERSHIP
Enter under TOTAL PAYROLL the quarterly (quarterly filers) or monthly totals
(monthly filers) of all compensation paid all employees. Deduct any payments
for services performed outside Fayette County and enter balances in SUBJECT
PAYROLL column. SUBJECT PAYROLL includes all compensation, i.e. vacation
and holiday pay, tips and gratuities.
OR NAME AND ADDRESS SHOWN BELOW
