FAYETTE COUNTY PUBLIC SCHOOLS                                                             Form 220-221-S 
         Employer’s Return of Occupational License Tax Withheld for Schools                                                  201 9
                                                              1. Subject Payroll
                                                                                                                 $           OFFICE USE ONLY 
                                                              2. Employee license tax withheld @0.5%             $            Transaction Number 
                                                              3. Balance Due
                                                                                                                 $ 
                                                              4. Credits (attach explanation)
Account Number         Period Ending                 Due Date                                                    $ 
                                                              5. Interest - 1% per month or portion thereof
                                                                                                                 $ 
                                                              6. Penalty @5% per month or portion thereof, not to
                                                                 exceed 25%. Minimum penalty $25.00. 
Mail to: TAX COLLECTION OFFICE                                                                                   $ 
         FAYETTE COUNTY PUBLIC SCHOOLS                        7. Net payment due (Lines 3,4,5 and 6)             $ 
         P.O. BOX 55570 
         LEXINGTON, KY  40555-5570                            I certify that the information is correct. 
                                                                                                                   Signature Date
                        Make check or money order payable to Fayette County Public Schools or (FCPS).