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o MAKE CHECK PAYABLE TO LFUCG
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Date
Actual license fee remitted for the year on Form 220/221
Difference between lines 15 and 16 (if any, check applicable box below)
LEXINGTON-FAYETTE URBAN COUNTY GOVERNMENT
2020 RECONCILIATION OF LICENSE FEE WITHHELD
Account Number
Federal ID or SSN
During year ended December 31, 2020
To be filed by February 28, 2021
Total Year
Actual license fee withheld per W-2's
Enter the larger of line 13 or line 14.
November
December or 4th Qtr.
October
January
February
March or 1st Qtr.
April
May
June or 2nd Qtr.
July
August
September or 3rd Qtr.
LICENSE FEE DUE
TOTAL PAYROLL
SUBJECT PAYROLL
PLEASE NOTIFY THIS OFFICE OF ANY CHANGE IN OWNERSHIP OR
NAME AND ADDRESS SHOWN BELOW
Division of Revenue
PO BOX 14058
LEXINGTON KY 40512
For each of the following benefits:
Did your employees
participate in?
Was the license fee
withheld?
Minor difference attributable to fractional variations only (no adjustment due)
Difference indicates insufficient total remittance for year. Check in payment attached
Difference indicates overpayments not attributable to fractional variations. Full explanation
and claim for refund is attached
Title
USE REVERSE SIDE FOR EMPLOYEE LISTING
Signature
Number of Employees:
a) Deferred compensation
b) Cafeteria plan
c) Group-term life insurance over $50,000
d) Other?
e) Other?
f) Other?
Form 222 /17 RCB - Revised 11/19
click to sign
signature
click to edit
Form 222 /17 RCB - Revised 11/19
NAME, ADDRESS & SOCIAL SECURITY NUMBER OF EMPLOYEE
Total Earnings
for the Year
License Fee Withheld
If report is completed on this page total here