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QUESTIONNAIRE AND INITIAL REPORTING
FOR AN OCCUPATIONAL LICENSE FEE ACCOUNT
OFFICE USE ONLY
Account # Validating Number
An initial fee of $100.00 (make check payable to LFUCG) must be enclosed
withthequestionnairewhenitisreturned.NON-PROFITorganizations willnot Amount Special Code (circle)
be required to make the $100.00 initial payment norfile Form228, NetProfit
License Fee return, provided a copy of the federal letter of exemption is $ R D B M S G A E
submitted to support the non-profit status. Section 13-13 of the Code of Business Code Payment Type FYE
Ordinances provides for annual regulatory or minimum fees that are Cash
applicable to varied types of businesses NOT IN ADDITION TO but INSTEAD Check
OF the above mentioned initial fee of $100.00 This fee may be used as a Date Assigned Collector Req. By
credit on the annual Net Profit License Fee Return (Form 228) when it
becomes due.
Return to: Division of Revenue, P O Box 14058, Lexington, KY 40512
1) Business or Trade Name:
2) Doing Business As:
3) Local Business Address:
(No P O Boxes) Zip Code
4) Homes Address:
Zip Code
5) Mailing Address For Forms if Different:
Zip Code
o Check if Mailing Address is to a tax preparer which is not an employee of your business. If so, you must complete Lines 2 and/or 3 above.
6) E-mail Address:
7) Telephone Numbers: Business: Fax: Home:
8) Ownership: o Sole Proprietor o Partnership o Corporation o S Corporation
o LLC/Sole Proprietor o LLC/Partnership o LLC/Corporation o LLC/S Corporation
o Non-Profit (attach federal exemption letter) o Other
9) Name of owner(s), partners, or corporate officers:
10) Social Security Number: Federal ID #:
11) Nature of Business:
12) Date Business Started in Fayette County: Do you have employees? o Yes o No
13) Is the business properly zoned, and has a Certificate of Occupancy been obtained? o Yes o No
If "NO", contact the Division of Building Inspection, 101 E. Vine St., 2nd Floor, Lexington, KY Telephone 859-258-3770
14) Accounting period per federal income tax return? o Calendar Year o Fiscal Year (month/day)
15) Do you have any other business entities in Fayette County? o Yes o No
If "YES", list the business name(s):
I certify that, to the best of my knowledge, the above information is true, accurate, and complete.
Signature Title Date
Form 228IP Revised 11-2016
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