Due Date: April 15
th
or 15
th
day of fourth month following close of Fiscal Year
Extension Date: October 15th
CITY OF MORGANTOWN NET PROFIT FEE FOR YEAR ENDING
NET PROFIT LICENSE FEE RETURN
THIS FORM MUST BE COMPLETED IN ITS ENTIRETY. IF FEDERAL ID OR SOCIAL SECURITY NUMBER IS OMITTED, THIS FORM WILL BE RETURNED TO
YOU. IF ADDRESS CHANGE APPLIES, YOU MUST CHECK THE ADDRESS CHANGE BOX.
BUSINESS NAME: BUSINESS PHONE:
BUSINESS ADDRESS: BUSINESS EMAIL:
BUSINESS FAX:
BUSINESS FEDERAL ID OR SOCIAL SECURITY: ⃝ Check here if there is an address change.
⃝ CHECK IF FINAL RETURN Date Operations Ceased: (Required to close account)
ALL LICENSEES MUST ANSWER THE QUESTIONS BELOW.
A. Principle business activity:
B. Principle Owner/Administrative Officer:
Address: Phone Number:
C. Was business activity discontinued?: When?: ⃝For Dissolution ⃝ For Sale/Transfer
If Sale/Transfer, state successor:
Name and Address:
D. Did you have employees in the City of Morgantown?: ⃝ Yes ⃝ No
E. Has City of Morgantown License fee been withheld from all subject employees and remitted quarterly in accordance with
regulations? ⃝ Yes ⃝ No
If answer is no, explain:
⃝ Yes ⃝ No Did you make payments in the sum of $600.00 or more to any individual for services rendered in the City of
Morgantown other than an employee? (If yes, you are required to file copies of FEDERAL FORM 1099.)
ALL LICENSEES MUST COMPLETE PAGE 2 OF THIS FORM BEFORE COMPLETING THIS SECTION
20. Enter ADJUSTED NET PROFIT (From Line 15 on back of this form)
21. Enter percentage from Line 18 or 19
22. Net Profits Allocation (Line 20 x Line 21)
23. City of Morgantown License Fee (Line 22 x 2%)
24. Credits: Estimated Payments
25. Balance of License Fees Due (Line 23 minus Line 24)
26. Penalty- 5% per month, not to exceed 25%- Minimum $25.00
27. Interest- 12% per annum
29. Overpayment ⃝ Credit ⃝ Refund
I hereby certify, under penalty of perjury, that the statements made herein and any supporting schedules are true, correct and complete to the
best of my knowledge.
Preparer Signature (Return must be signed) Date Taxpayer Signature (Return must be signed) Date
Print Name Print Name
Address Phone Number Title
Make check payable to: City of Morgantown
Mail this form along with supporting schedules to: City of Morgantown, PO Box 397, Morgantown, KY 42261
This return must be filed and paid in full by the fifteenth day of the fourth month after the close of the fiscal/calendar year unless an extension of time to file has
been granted.
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