MAILING ADDRESS: P.O. BOX 32300, LOUISVILLE, KENTUCKY 40232-2300
Telephone: (502) 574-4860
Louisville Metro Revenue Commission
EMPLOYERS QUARTERLY RETURN OF
OCCUPATIONAL FEES WITHHELD
INDIVIDUAL/ SOLE PROPRIETOR
Legal name/ Business name
CHECK IF CHANGE IN ADDRESS IS BELOW
Address (number and street)
City, town, or post office
STATUS
If you had no employees this quarter, do not complete Lines 1 through 13
Calculation due
Enter amounts earned for
work performed in
Louisville Metro only on
Line 1-5
If Line 6 is greater than
$3,000.00, you must begin
making monthly deposits
beginning next quarter.
(See instructions)
Total Wages earned by employees for work that
was performed within Louisville Metro, KY.
(Exclude amounts earned by ordained ministers)
Wages earned by non-resident employees for work
that was performed within Louisville Metro, KY.
(Exclude amounts earned by ordained ministers)
Total Wages earned by resident employees for
work performed within Louisville Metro, KY.
1 minus Line 2)
Amount of wages earned by Resident Ministers
Total wages subject to the School Board Tax
(Line 3 +
Line 4)
Total Tax due (Line 1a + Line 5a)
Credits
Lines 9a-9c must reflect
amounts that should have
been paid for each month;
the sum must be equal to
the Total Tax Due (Line 6)
Penalty & Interest (See instructions)
Total Amount Due (Line 6 + Line 7)
Monthly Deposits Due
(For Depositors Only)
Total Deposits paid for this Quarter
Additional payment Due (If Line 8 > Line 10)
OVERPAYMENT TO BE CREDITED TO NEXT QUARTER
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OVERPAYMENT TO BE REFUNDED
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I hereby certify, under penalty of perjury, that the information provided and the attached supporting schedules are true, correct, and
complete to the best of my knowledge.
Use Only
Print/Type preparer’s name
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Register for electronic filing. It is an easy, secure, and convenient way to file and pay taxes on-line. For more information log on to
https://www.metrorevenue.org
