LOGANPLEASE NOTIFYCOUNTYOF ANY ADDRESSNETCHANGE_PROFITSRUSSELLVILLELICENSEKY 42276FEE RETURN
                                  1. Gross Receipts/Sales and Other Income per attached Federal
** IMPORTANT **                         Return _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _         1
COPY OF APPLICABLE
FEDERAL RETURN OR                 2. Cost of Goods Sold and/or Operations plus other Federal
SCHEDULE(S) MUST BE                       Pre-Gross income Deductions _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _            2

ENCLOSED                                                                                                             3
                                  3.   Gross income per attached Federal Return (Line 1 less Line 2) _ _
Fed. Sch. C,E.F,   
Fed. 1040,1065, 1120, 1120 (s)    4. Total Deductions per attached Federal Return _ _ _ _ _ _ _ _ _ _ _ _            4
FEDERAL RETURN                    5. Net Profit/income per attached Federal Return
SHOULD INCLUDE:                          (Line 3 less Line 4) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _          5
1) Cost of Goods Sold Schedule
2) Schedule of "Other Deductions" 6. Add items not Deductible (Line 24, Section B on Back) _ _ _ _                   6

Make Checks Payable To:           7.  Total (Line5 plus Line 6) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _              7
Logan County Treasurer
                                  8. Subtract Items not Subject (Line 30, Section B on Back) _ _ _ _                 8
  Mail To:
Occupational/Net Profits Tax
                                  9. Adjusted Net Profit/Income (Line 7 less Line 8) _ _ _ _ _ _ _ _ _               9
P.O. Box 236
Russellville, Ky 42276
                                  10. Average Percentage if Applicable (Line 34, Section C on Back) _ _ _            10                                 %
Phone (270) 726-4667
Fax:  (270) 726-4668              11. Net Profit Subject to License Fee (Line 9 multiplied by Line 10) _ _ _         11

SPACE FOR OFFICE USE ONLY         12. License Fee Due .75% (Multiply Line 11 by .0075) _ _ _ _ _ _ _ _ _             12
                                  13. Credits, Estimated Payments           _ _ _ _ _ _ _ _ _ _ _ _                  13
                                  14. Refund or Credit. If Line 13 is Greater that Line 12 enter the
                                           difference ( Circle one:   REFUND  or  CREDIT ) _ _ _ _ _ _ _ _ _         14

                                  15. BALANCE DUE  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 15
                                  16. Interest - 1% per month or portion of month Beginning 1st day
                                                 after Original Due Date _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 16
                                  17. Penalty - 5% per month or portion of a month or $25 whichever is
                                  greater.  It shall not be less than $25.00 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 17

                                  18. Total amount due (add lines 15, 16 and 17) _ _ _ _ _ _ _ _ _ _ _ _             18

I hereby certify that the statements made herein and in any supporting schedules are true, correct and complete to the best of my knowledge
X  _____________________________________               RETURN MUST X  ___________________________________________
Signature of Individual Preparing Return Date  & Phone BE SIGNED.                                                                Date
                                                                                  Signature of Taxpayer

IF FILING AN EXTENSION PLEASE SUBMIT A COPY OF IT BEFORE THE DUE DATE ON THIS RETURN. 
 *All returns must be post-marked by the due date or the extension date, (if an extension was filed/granted with our office) to avoid penalty charges.  Filing an
extension only extends your time to file. It does not extend you time to pay. Regardless of the number of extensions filed , interest is 1% per month or portion
of a month, beginning the first day you file after the original due date.  Zero returns that are filed late will have the $25.00 minimum penalty charge.

FOR  YEAR ENDED                                                                                     SSN # and/or FED ID
                                               DUE DATE
MONTH DAY                   YEAR         MONTH         DAY        YEAR
                                                                                   BUSINESS CLASSIFICATION (CHECK ONE):
                                                                                  CORPORATION                        PARTNERSHIP           LLC
      COUNTY OCCUPATIONAL ACCOUNT NUMBER
                                                                                   INDIVIDUAL                        FIDUCIARY   OTHER

                                                                                  Is this a NEW account       YES             NO
                      MAILING ADDRESS                                             Date Business Activity Began____________

                                                                                  CHECK IF FINAL RETURN 
                                                                                  Date Business Activity Ceased______________
                                                                                           For Dissolution                   Sale/Transfer

                                                                                                                        LCNP -9/9/2014