www.metrorevenue.org (502) 574-4860
LO
UISVILLE METRO REVENUE COMMISSION
ELECTRONIC FILING or ELECTRONIC PAYMENT WAIVER REQUEST
Complete this form to request a waiver if you are unable to electronically file or pay your W-1, W-2, W-3
or information returns or statements (including Form 1099 SF and the IRS Forms 1099 series).
Waivers are granted by tax year. Provide the tax year for which the waiver is being requested. In the
event that a waivers is needed for any subsequent tax year a new waiver with supporting
documentation will need to be submitted.
Waiver Requested for Tax Year:_______________________
T
ax and/or Document Type (check all that apply):
W-1 Reportin
g
W-2 R
eporting
1099 SF or IRS Series
W-1 Withholding Deposits
W-3 Reporting
Other Reporting, List Type: ______________________________________________________
Business Information
Tax and/or Payroll Preparers submitting requests for multiple businesses – Provide your contact
information below and attach a list of all businesses represented in this request and include the Business
Name/Sole Proprietor Name, FEIN (or SSN for Sole-Proprietor) , and Louisville Metro Revenue Commission
Tax Account Number of each. The notice of approval or notice of denial will be sent to the requestor.
All others provide the following information:
Business Name/Sole Proprietor Name:_____________________________________________________
Number of Employees:__________________________________________________________________
FEIN (or SSN for Sole Proprietor): _________________________________________________________
Revenue Commission Tax Account Number: ________________________________________________
Email Address: ________________________________________________________________________
Mailing Address: _______________________________________________________________________
City:___________________________________________________ State:______ Zip:________________
Contact Name:____________________________________ Phone Number:_______________________
Waiver Request Details, Justification and Compliance Plan
Attach written explanation and/or justification of the need for a waiver of the electronic filing or payment
requirement along with any supporting documentation. Provide the details of how you will submit
documentation and/or payment if the waiver is approved. Please also provide an anticipated compliance
date and/or any plan for achieving compliance with the electronic filing and/or deposit requirements.
Mail c
ompleted form and supporting documentation to:
PO BOX 32060, LOUISVILLE, KENTUCKY 40232-2060
Allow 45 days from time of filing waiver request for processing of Notice of Approval or Notice of Denial.
