Louisville Metro Revenue Commission 
          EMPLOYERS QUARTERLY RETURN OF 
          OCCUPATIONAL FEES WITHHELD                                                                                                   Form 
                                                                                                           W-1_2018_V1.0                    W-1
▼        INDIVIDUAL/ SOLE PROPRIETOR            ▼ 
Last name                                                                       First name                 MI                      Social Security Number 

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

      CHECK IF CHANGE IN ADDRESS IS BELOW 
Address (number and street)                                                                  Unit/Apt. no.                                         
                                                                                                                                   Account ID

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

Email                                                             Phone no.                  Ext.                                  No Employees 
                                                                                                                                   Amended Return 
                                                                                                                                   Final Return 
If you had no employees this quarter, do not complete Lines 1 through 13 
                                                                                                                  RETURN STATUS    Employee Cease Date 

                                              WAGE INFORMATION                      QUARTERLY WAGES        RATE                        TAX COMPUTATION 
                                                                                             Column 1                                  (Column 1 X RATE) 
Withholding                1.  Total Wages earned by employees for work that 
                               was performed within Louisville Metro, KY.     
Calculation due                (Exclude amounts earned by ordained ministers)                                                      1a. 
Enter amounts earned for                                                                                   .0145                 
work performed in          2.  Wages earned by non-resident employees for work 
Louisville Metro only on       that was performed within Louisville Metro, KY.  
Line 1-5                       (Exclude amounts earned by ordained ministers) 
                           3.  Total Wages earned by resident employees for 
If Line 6 is greater than      work performed within Louisville Metro, KY.  
$3,000.00, you must begin      (Lines 1 minus Line 2) 
making monthly deposits    4.  Amount of wages earned by Resident Ministers 
beginning next quarter. 
(See instructions)         5.  Total wages subject to the School Board Tax  
                               (Line 3 + Line 4)                                                           .0075                   5a. 
                           6.  Total Tax due  (Line 1a + Line 5a) 
Payments &                 7.  Penalty & Interest (See instructions) 
                           8.  Total Amount Due (Line 6 + Line 7)
Credits                                                            
Lines 9a-9c must reflect   9.  Monthly Deposits Due 
amounts that should have       (For Depositors Only)  9a.                       9b.                   9c. 
been paid for each month; 
the sum  must be equal to  10.  Total Deposits paid for this Quarter  
the Total Tax Due (Line 6) 11.  Additional payment Due (If Line 8 > Line 10) 
Overpayment                12. OVERPAYMENT TO BE CREDITED TO NEXT QUARTER                                                        ▶ 
                           13. OVERPAYMENT TO BE REFUNDED                                                                        ▶ 
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 EIN   ▶
                           Firm’s name       
                           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