LINCOLN COUNTY 
                               OCCUPATIONAL TAX SERVICES

                                            Annual Occupational License Return
                               This return is due on or before April 15 for the Calendar Year or within 105 days of the Fiscal Year end. 
    CHECK IF FINAL RETURN           DATE OPERATIONS CEASED                       (Required to close account)                                 CHECK IF "NO ACTIVITY" FOR YEAR
    CHECK IF CHANGE IN ADDRESS IS BELOW                               CHECK IF AMENDED RETURN
                                                                                                                                             ACCOUNT NUMBER
Name
Address                                                                                                                                      FOR YEAR ENDING
                                                                                                                                             MM/DD/YYYY
City                                                            State            Zip
Federal ID                                         Phone No.                     Ext
                                                         *THE QUESTIONS BELOW MUST BE ANSWERED *
A. Principal business activity:
B. During the past year, did Federal Authorities change or propose to change net income reported for that year or any prior year? YES         NO
If YES, which year(s) was adjusted?                             (Attach statement of changes)
C. Corporation's Principal Administrative Officer:                                                                      Social Security Number
Address:
D. Did you file a consolidated federal return? YES           NO       If YES, see instructions
E. Was there a change in ownership in the past year? YES        NO    If YES, when did the change occur?
     Please provide the name and address of new owner:
YES        NO                  Did you make payments in the sum of $600.00 or more to any individual for services rendered in Lincoln County, Kentucky, other than 
                               an employee? IF YES, YOU ARE REQUIRED TO SUBMIT COPIES OF 1099'S.
                                    * PAGE 2 MUST BE COMPLETED PRIOR TO COMPLETING THIS NEXT SECTION *
24. Enter ADJUSTED NET PROFIT (From Iine 19 on page 2 of form):                                                                              $
                                                                      COLUMN A                                                                  IMPORTANT
           Occupational License Tax Computations                       Occupational License                                                     Please write your 
                                                                      Tax Rate = (1.0%)                                                         account number 
                                                                                                                                                on your check or 
25.Enter Apportionment Percentage (100% or % from line 23)                                                  %                                   money order and 
26. Net Profits Allocation (Line 24 X Line 25)                                                                                                  make payable to:
27. Enter result of Line 1(e)                                                                                                                   Lincoln County 
28. Enter the sum of Line 26 + Line 27                                                                                                          Tax Administrator 
29. TAX CALCULATIONS - [Line 28, Column A x .01] 
30. TOTAL OCCUPATIONAL TAX DUE -  Line 29

31. Enter any credit due       (a) Prepayment of tax                  (b) Refund                                        (c) Credit to next year
32. BALANCE OF OCCUPATIONAL LICENSE TAX DUE [Line 30 minus Line 31(a)]
33. PENALTY AND INTEREST (Minimum $25.00 penalty for failure to file/pay by the due date. See Instructions):
34. AMOUNT TO BE PAID (Add Lines 32 and 33):
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.

Preparer's Signature (Return must be signed.)        Date                        Signature of Licensee (Return must be signed.)                 Date

Print Name                                           Federal ID                  Print Name                                                     Title

Address                                              Phone No.                                              Federal ID/Social Security Number
           ATTENTION: Federal ID Numbers and Social Security Numbers must be supplied for both the Tax Preparer and the Licensee.
                                            MAILING ADDRESS: 102 E Main Street, Ste 3, Stanford, Kentucky 40484 
                                    Telephone: (606) 365-4520 * www.lincolnky.com * Fax:  606) 365-4520(

                                                                                                                                                                   Form OL

                                                                                                                                                                     Page 2 of2 
Lines 1(a) through 1(e) apply only to individuals with income reported on Federal W-2 Form from which no occupational taxes were withheld.
1 (a). Gross salaries, wages, tips, etc. reported on the Federal Form W-2 from which no occupational taxes were withheld, plus deferred                    1 (a)
       compensation from 401 (K), 403 (B) or 457 plans
1 (b). Related employee business expenses per Federal Form 2106 (Attach Form W-2 and Form 2106)                                                            1 (b)
1 (c). Line 1 (a) minus Line 1 (b)                                                                                                                         1 (c)
1(d). If your payroll is exclusive to Lincoln County, enter 100%.  Otherwise, compute the apportionment below for the time spent in Lincoln
       County, carrying the percentage out five (5) decimal places. EXAMPLE: ''22.12345%'' or ''.2212345''

                                                                                       ÷                                                                   1 (d)                   %
                Total Days Worked in Lincoln County                                      Total Days Worked Everywhere                   =
1(e). Multiply Line 1(c) by Line 1(d) and enter on Line 27, Column A on the front page.                                                                    1 (e)

                          COMPLETE THE APPLICABLE COLUMN AND ATTACH CORRESPONDING FEDERAL SCHEDULES
                                                                                                                   INDIVIDUAL                  PARTNERSHIP           CORPORATION
2.Non-employee compensation as reported on Form 1099-MISC reported as ''other                                 2)
income'' on Federal Form 1040 (Attach Page 1 of Form 1040 and Form 1099)
3.Net profit or (loss) per Federal Schedule C of Form 1040 (Attach Schedule C, Pages                          3)
1 and 2, Schedule C-EZ)
4. Capital gain from Federal Form 4797 or Form 6252 reported on Schedule D of                                 4)
Form 1040 (Attach Form 4797, Pages 1 and 2 or Form 6252)
5.Rental income or (loss) per Federal Schedule E of Form 1040 (Attach Schedule E)                             5)
6.Net farm profit or (loss) per Federal Schedule F of Form 1040 (Attach Schedule F,                           6)
pages 1 and 2)
7. Ordinary gain or (loss) on the sale of property used in a trade or business per                            7)
Federal Form 4797 (Attach Form 4797, Pages 1 and 2)
8. Ordinary income or (loss) per Federal Form 1065 (Attach Form 1065, Pages 1, 2, 3,                                                    8)
and 4, Schedule of Other Deductions, and Rental Schedule(s), if applicable)
9.Taxable Income or (loss) per Federal Form 1120 or 1120A or Ordinary income or
(loss) per Federal Form 1120S (Attach Form 1120 or 1120A, Pages 1 and 2 or                                                                                 9)
1120S, Pages 1, 2, and 3, Schedule of 0ther Deductions, and Rental Schedule(s), if
applicable)

10.StateE, F,Incomeor FormTaxes1065,1120S,and Occupational1120A, orTaxes1120Sdeducted on Federal Schedule C,  10)                       10)                10)
11.Additions from Schedule K of Form 1065 or Form 1120S (Attach Schedule K of                                                           11)                11)
Form 1065 or 1120S and Rental Schedule(s), if applicable)
12. Net Operating Loss deducted on Form 1120                                                                                                               12)

13.TOTAL INCOME - Add Lines 2 through Line 12                                                                 13)                       13)                13)
14.Subtractions from Schedule K of Form 1065 or Form 1120S
    (Attach Schedule K of form 1065 or 1120S and Rental Schedule(s), if applicable)                                                     14)                14)
15.Other Adjustments (Attach Schedule)                                                                       15)                        15)                15)
16. Non-Taxable Income (Attach Schedule)                                                                                                16)                16)

17.Professional Expenses not reimbursed by the Partnership (Attach Schedule of                                                          17)
Expenses)

18. TOTAL DEDUCTIONS - Add Lines 14 through Line 17                                                           18)                       18)                18)

19. Adjusted Net Profit - Subtract Line 18 from Line 13 Enter here and on Line 2 4on                         19)                        19)                19)
    the front page [Do Not include the amount from Iine 1(e)]
                                                                                      COMPUTATION OF APPORTIONMENT PERCENTAGES
Businesses whose total    gross receipts and/or payroll were not confined solely to Lincoln County, Kentucky, must complete Lines 20-23.                             COLUMN C =
All percentages in Column C must be carried out five (5) decimal places.  Otherwise, enter 100% on line 25.                                                          Column A /Column B
                          APPORTIONMENT CALCULATION                                                               LINCOLNCOLUMNCOUNTY A     TOTAL COLUMNEVERYWHERE B LINCOLNCOLUMNCOUNTYC%
20. Gross income from sales made and/or services rendered                                                 20 (a)                        20 (b)             20(c)
21. Total  wages, salaries, and other compensation paid                                                   21(a)                         21(b)              21(c)
 (If not applicable, write N/A in column C; See Instructions before completing)
22. TOTAL APPORTIONMENT PERCENTAGE for Lincoln County, KY      Add Lines20                                  ( c) and ( (21 c)                              22
23. APPORTIONMENT PERCENTAGE - [If both Lines 20 and 21 are applicable, divide entry on Line 22 by 2. Enter here and on Line 25
    on the front page. If either Line 20 or Line 21 is not applicable, enter the amount from Line22  here and on Line 25 on the front page.]               23
    EXAMPLE: ''22.12345%'' or ''.2212345''