Louisville Metro Revenue Commission 

             Monthly Withholding Deposit Form 
                                                                                                         W1_2018_V1.0
                                                                                                                        Form 
                                                                                                                             W1 D
▼     INDIVIDUAL/ SOLE PROPRIETOR    ▼ 
Last name                                                    First name                           MI          Social Security Number 

▼     CORPORATION/ PARTNERSHIP       ▼ 
Legal name/ Business name                                                                                       Federal ID Number 

Address (number and street)                                                         Unit/Apt. no.                Account ID 

City, town, or post office                            State                         Zip code                     Quarter Ending 

Email                                                 Phone no.                     Ext.                        Deposit Amount 
                                                                                                        $ 
                           Every employer who is responsible for withholding occupational license fees of greater than $3,000.00 during any one 
Requirement for            of the four (4) preceding quarters must submit monthly deposits of the occupational license taxes withheld to the 
                           Louisville Metro Revenue Commission.  
payment of tax 
                                                             CHECK APPLICABLE MONTH DEPOSIT IS FOR 
                           
All monthly      ▶                January                   April                           July                     October
withholding tax            Due Date: February 15 th   Due Date: May 15 th           Due Date: August 15 th      Due Date: November 15 th

deposits are due                 February                  May                             August                   November
fifteen (15) days after 
the month end.             Due Date: March 15 th      Due Date: June 15 th          Due Date: September 15 th   Due Date: December 15 th

                                 March                     June                            September                December
                            Due Date: April 15 th     Due Date: July 15 th          Due Date: October 15 th      Due Date: January 15 th

General                    All employers will be required to file a quarterly withholding tax return (FORM W-1) by the last day of the month 
                           following the close of the calendar quarter. Pursuant to KRS 67.790, there is a minimum $25.00 penalty for 
Information                failure to file any return or report and/or make payment by the due date. 
                                              License Fee Return For                                       Filed by 
                                                                                                  (Postmarked or Hand Delivered) 
                                                 1 stQuarter                                              April 30 th
                                                 2 ndQuarter                                               July 31 st
                                                 3 rdQuarter                                            October 31  st
                                                 4 thQuarter                                             January 31   st
Signature                  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. 
                           Your signature                                                                     Date 

                           Print/Type your name                 Your Title                              Daytime phone number 

Preparer                   Print/Type preparer’s name Preparer’s signature               Date        PTIN 
Use Only 
                           Firm’s name      ▶                                                        Firm’s EIN   ▶
                           Firm’s address   ▶                                                        Phone no. ▶ 

                                                             ELECTRONIC FILING: 
    Register for electronic filing. It is an easy, secure, and convenient way to file and pay taxes on-line. For more information log on to 
                                                      https://www.metrorevenue.org 

                                   MAILING ADDRESS: P.O. BOX 32300, LOUISVILLE, KENTUCKY 40232-2300 
                                                      Telephone: (502) 574-4860