TO BE FILED WITH THE 4th QUARTER'S RETURN BY ___/___/_____
____/____/______
Reconciliation of License Fee Withheld
During Year Ended
OR WITH THE FINAL QUARTERLY RETURN OF THE CLOSING
OF ANY BUSINESS EITHER BY SALE OR DISSOLUTION.
Prepare In Duplicate
Mail OriginalTo:
MCCRACKEN COUNTY
TAX ADMINISTRATOR
PADUCAH KY 42002-2658
P O BOX 2658
EMPLOYER'S NAME AND ADDRESS
Phone Number
Federal I.D. Number
TOTAL NUMBER OF EMPLOYEES FOR THE YEAR
ANNUAL RECONCILIATION
(1) Total Wages Paid For The Year
(2) Total License Fee Withheld For The Year
$
$
January
Febuary
March
April
May
June
July
August
September
October
November
December
$
$
$
$
1st
2nd
3rd
4th
COLUMN A
COLUMN B
COLUMN C
Monthly Payments
Quarterly Payments
Total For Year
$
(3)
(Line 3 Must Equal Line 2)
Print Form