Lincoln County Occupational Tax Services 
                                                  102 East Main St  •   Stanford, KY 40484Telephone: 
                                                             (606) 365-4520  •  Fax:  (606) 365-4520 
                                                                       www.lincolnky.com   

                           REGISTRATION APPLICATION FOR TAX ACCOUNT NUMBER 

 * According to an opinion of the Kentucky Attorney General (OAG 85-1), and  pursuant to Kentucky “Open Records Law”, responses entered for
 Lines 1, 2, 7, and 9 are to be provided to anyone upon request.  * 
 Everyone subject to the Lincoln County Occupational License Tax must complete and submit this application to the Lincoln County Occupational Tax 
 Services Office to be assigned a tax account number. 
                                                           PLEASE TYPE OR PRINT CLEARLY. 
 1. Full legal name (first, middle, and last) of the individual, corporation, partnership, or other business entity applying for this number:

 2. Trade name of business (if different than name entered on Line 1):

 3. Check your “federal” business entity type:
       Sole Proprietor/Individual – Will submit Schedules C, D, E, or F of            Corporation – Will submit Federal Form 1120 
    Federal Form 1040; or Federal Form W-2; or Federal Form 1099-MISC      Attach name, home addresses, and SSN of corporate officer(s) 
       Partnership – Will submit Federal Form 1065 and its Schedule K                 S-Corporation – Will submit Federal Form 1120S and its Schedule K 
    Attach name, home addresses, and SSN of all partners                   Attach name, home addresses, and SSN of corporate officer(s) 
 4. Check if your business operates as an:
       Association -Attach IRS authorization               Non-Profit Organization -Attach  IRS authorization            Professional Employer Organization 
 5. If you are an Individual/Sole Proprietor, enter your Social Security Number:  _______ - _____ - _______.
 6. If you are a Partnership, Corporation, S-Corporation, or Sole Proprietor with employees, enter your Federal Tax ID Number.  ____ - __________________.
 7. Describe the :  ________________________________________________________
 8. Mailing address for  tax forms and correspondence                      9.         Your primary business address
 Street Address:                                                           Street Address (Do not enter a P.O. Box): 
  
 City, State, Zip Code (Provide all 9 digits, if known):                   City, State, Zip Code (Provide all 9 digits, if known): 

 Email Address:                                                            Email Address: 
 Day Phone:  (       )                 Fax Number:  (        )             Day Phone:  (       )                         Fax Number:  (        ) 
 Check here  if you want tax forms sent to the address entered in Question 8.  Tax forms can be found on our website, www.lincolnky.com.

 10. YourLincoln County, Kentucky, business address                        11.        Your home address  (Individual/Sole Proprietor accounts only) 
 Street Address (Do not enter a P.O. Box):                                 Street Address (Do not enter a P.O. Box): 

 City, State, and Zip Code (Provide all 9 digits, if known):               City, State, and Zip Code (Provide all 9 digits, if known): 

 Day Phone:  (       )                 Fax Number:  (        )             Day Phone:  (       )                         Fax Number:  (        ) 
 12. Provide the current tax year end, if not December.   (Must be the same as "federal")
 13. Date business started, or will start, within Lincoln County, KY.
 14. Date income was earned for work performed within Lincoln County, KY, with no local tax withheld.
 15. Has your business activity stopped within Lincoln County, KY?     Yes          No        If yes, enter stop date. 
 16. First date you paid or anticipate paying employee(s) for work in Lincoln County, KY.   (Do not include “contract labor”)
 17(a.)  If you obtained the business from a previous owner or your business entity type changed, enter date of acquisition/change. 
 17(b.)  If a business acquisition or a change in organization/business entity type occurred, provide the following: 

 Name of Previous Owner or Organization                                Former Trade Name (if any)                                            Account Number 

                                                                                                                                    ate: 
 Applicant’s Signature  

 Applicant’s Name (print)                                                                                                             ---OFFICE USE ONLY--- 
                                                                                                                                      Account Number Assigned