Due Dates: 20
day of the month following the month the tax was collected
City of Morgantown
Restaurant Tax Return
Year: Taxable Month:
Name of Business: Phone:
Business Address: E-mail:
City, State, and Zip: Fax:
If this business is no longer in operation, please provide the date operation was terminated:
1. Total Gross Receipts of business in Morgantown (all receipts): $
2. Less receipts collected for non-taxable items: ( )
3. Taxable Receipts $
4. Actual Tax Due for Month at 3%: $
5. Interest 1.5% per month after Due Date: $
6. Penalty*: $
7. Total Taxes Due Including
Interest & Penalty: $
*PENALTY: After (30) days from due date, 10% per month, not to exceed 25%. Minimum penalty amount $50.
If no receipts were collected this month, mark “none” on line 6 and return this form with explanation. Notify City of
Morgantown of any change in ownership.
Signature Title Date
I hereby certify, under penalty of perjury, that the statements made herein and in any supporting schedules are
true, correct and complete to the best of my knowledge
• A copy of this form must accompany your payment. You should retain a copy for your records.
• This return must be filed whether you had taxable receipts during this period or not.
• All businesses receiving this form MUST return a form
1. Enter the amount from Line 22 of the Kentucky Sales and Use Tax Form (for Morgantown locations only)
2. Enter total receipts from sale for non-food and/or alcoholic beverage items included in Line 1.
3. Line 1 minus Line 2.
4. Multiply Line 3 by .03
5. For each month or fraction thereof that the return or payment is late, add Lines 3 & 4 and multiply by 1.5%
6. See Penalty Section and apply applicable penalties.
7. Enter the total of Line 4, Line 5 and Line 6
Send check payable to: City of Morgantown, PO Box 397, Morgantown, KY 42261
Contact Information: Jerrod Barks | 270-526-3557 | firstname.lastname@example.org
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