Louisville Metro Revenue Commission 

          Statement of Non-Employee Compensation                                                                                 Form 
                                                                                                            1099SF_2018_V1.0          1099-SF 
▼     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                     Calendar Year 

Email                                                   Phone no.                    Ext.                   If Column 5 is not completed, total 
                                                                                                            compensation will be calculated at 100%. 
                                                                 Compensation Information 
      If less than 100% of total compensation paid was for services performed in Louisville Metro, KY, Column 5 must be completed with the amount of 
                                                       compensation earned in Louisville Metro, KY. 
      Column 1                                         Column 2                           Column 3          Column 4                    Column 5 
  Recipient’s Name                      Recipient’s Address                               Recipient’s       Total Non-                Amount of Column 
                                                                                     identification Number  Employee                  4 earned in  
                                                                                                            Compensation              Louisville Metro 
                                                                                                            Paid 
                            Address (number and street)                Unit/Apt.no.  Social Security Number 

                            City, town, or post office           State Zip code      Federal ID Number                    .00                    .00 

                            Address (number and street)                Unit/Apt.no.  Social Security Number 

                            City, town, or post office           State Zip code      Federal ID Number                       .00                 .00 

                            Address (number and street)                Unit/Apt.no.  Social Security Number 

                            City, town, or post office           State Zip code      Federal ID Number                       .00                                  .00 

                            Address (number and street)                Unit/Apt.no.  Social Security Number 

                            City, town, or post office           State Zip code      Federal ID Number                       .00                                  .00 

                            Address (number and street)                Unit/Apt.no.  Social Security Number 

                            City, town, or post office           State Zip code      Federal ID Number                       .00                                  .00 

                            Address (number and street)                Unit/Apt.no.  Social Security Number 

                            City, town, or post office           State Zip code      Federal ID Number                       .00                                  .00 

                                                                                                    TOTAL                    .00                                  .00 
                           I hereby certify, under penalty of perjury, that the information provided and the attached supporting schedules are true, correct, and 
Signature                  complete to the best of my knowledge. 
                           Signature                                                                        Title 

                           Print Name                                                                       Date 

                                                                 ELECTRONIC FILING 
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                                                        https://www.metrorevenues.org  

                                      MAILING ADDRESS: P.O. BOX 32060, LOUISVILLE, KENTUCKY 40232-2060 
                                                        Telephone: (502) 574-4860