LOGAN COUNTY OCCUPATIONAL TAX
EMPLOYER'S/SELF EMPLOYEE RETURN OCCUPATIONAL TAX WITHHELD
If no wages were paid this period, mark "NONE" and return this form by the due date to avoid $25.00 PENALTY
1. Total salaries, wages, commissions & other $ _______________ 8. BALANCE DUE: $ ______________
compensation paid Account No.
2. Less compensation paid for Services outside Logan Co. $ _______________ CIRCLE ONE: MONTHLY, QUARTERLY OR YEARLY RETURN
3. Taxable Earnings (line 1 minus line 2) $ _______________ I hereby certify that the information, schedules, statements and
4. Actual Tax Due at 0.75% $ _______________LOGAN COUNTY OCCUPATIONAL TAXexhibits filed herewith are true and correct.
5. Adjustments for prior periods $ _______________ Signed _____________________________________________________
6. Penalty- 5% per month/part of a month -$25.00 minimum $ _______________
7. Interest- 1% per month/part of a month $ _______________ OfficialTitle ________________________________ Date ___________
FOR PERIOD ENDING Checks payable to Logan
Month Day Year Co Treasurer: AND mail to:
LOGAN COUNTY OC
CUPATIONAL TAX
RETURN DUE ON OR BEFORE P.O. BOX 236
Month Day Year RUSSELLVILLE KY 42276
Phone: (270) 726-4667
Fax: (270) 726-4668
Phone: logantaxes@bellsouth.net
Indicate any name or address change above.
MUST BE POST-MARKED BY DUE DATE TO AVOID PENALTY AND INTEREST Form OCC-3PT Rev. 10/5/2013
LOGAN COUNTY OCCUPATIONAL TAX
EMPLOYER'S/SELF EMPLOYEE RETURN OCCUPATIONAL TAX WITHHELD
If no wages were paid this period, mark "NONE" and return this form by the due date to avoid $25.00 PENALTY
1. Total salaries, wages, commissions & other $ _______________ 8. BALANCE DUE: $ ______________
compensation paid Account No.
2. Less compensation paid for Services outside Logan Co. $ _______________ CIRCLE ONE: MONTHLY, QUARTERLY OR YEARLY RETURN
3. Taxable Earnings (line 1 minus line 2) $ _______________ I hereby certify that the information, schedules, statements and
4. Actual Tax Due at 0.75% $ _______________ exhibits filed herewith are true and correct.
5. Adjustments for prior periods $ _______________ Signed _____________________________________________________
6. Penalty- 5% per month/part of a month -$25.00 minimum $ _______________
7. Interest- 1% per month/part of a month $ _______________ OfficialTitle ________________________________ Date ___________
FOR PERIOD ENDING Checks payable to Logan
Month Day Year Co Treasurer: AND mail to:
LOGAN COUNTY OC
CUPATIONAL TAX
RETURN DUE ON OR BEFORE P.O. BOX 236
Month Day Year RUSSELLVILLE KY 42276
Phone: (270) 726-4667
Fax: (270) 726-4668
Phone: logantaxes@bellsouth.net
Indicate any name or address change above.
MUST BE POST-MARKED BY DUE DATE TO AVOID PENALTY AND INTEREST Form OCC-3PT Rev. 10/5/2013
LOGAN COUNTY OCCUPATIONAL TAX
EMPLOYER'S/SELF EMPLOYEE RETURN OCCUPATIONAL TAX WITHHELD
If no wages were paid this period, mark "NONE" and return this form by the due date to avoid $25.00 PENALTY
1. Total salaries, wages, commissions & other $ _______________ 8. BALANCE DUE: $ ______________
compensation paid Account No.
2. Less compensation paid for Services outside Logan Co. $ _______________ CIRCLE ONE: MONTHLY, QUARTERLY OR YEARLY RETURN
3. Taxable Earnings (line 1 minus line 2) $ _______________ I hereby certify that the information, schedules, statements and
4. Actual Tax Due at 0.75% $ _______________ exhibits filed herewith are true and correct.
5. Adjustments for prior periods $ _______________ Signed _____________________________________________________
6. Penalty- 5% per month/part of a month -$25.00 minimum $ _______________
7. Interest- 1% per month/part of a month $ _______________ OfficialTitle ________________________________ Date ___________
FOR PERIOD ENDING Checks payable to Logan
Month Day Year Co Treasurer: AND mail to:
LOGAN COUNTY OC
CUPATIONAL TAX
RETURN DUE ON OR BEFORE P.O. BOX 236
Month Day Year RUSSELLVILLE KY 42276
Phone: (270) 726-4667
Fax: (270) 726-4668
Phone: logantaxes@bellsouth.net
Indicate any name or address change above.
MUST BE POST-MARKED BY DUE DATE TO AVOID PENALTY AND INTEREST Form OCC-3PT Rev. 10/5/2013