Madison County Finance Office
                                        NET PROFITS LICENSE FEE RETURN
                                                                           Account Number                              Calendar/Fiscal Year Ended
                                                                                                                       Month Day                        Year
Attach Federal Returns and any 
             Schedules that apply                                          Federal ID Number                                 Due Date

                                                                     Questions (ANSWER IN FULL)
                                                                     1. Nature of Business
                                                                     2. Date Business Started in this County
                                                                     3. If Business was Discontinued, State When
                                                                       (  ) by Dissolution or (  ) by Sale 
                                                                                   if by sale give Name and Address of successor

                                                                     4. Did you have employees in this County?   (  ) Yes    (  )  No
                                                                     5. Basis upon which tax return is prepared  (  ) Cash  (  ) Accrual
                                                                                           (  ) C-Corp  (  ) S-Corp  (  )  Partnership  (  )  Sole-prop.
                                                                     6. Business Type: (  ) Fiduciary (  )  Other (Specify)
                                                                     7. Has the IRS changed the Net Income as originally reported for 
                                                                     any prior year?    (  ) No  (  ) Yes 
Phone Number                                                                                                 If YES  (Attach Schedule of Changes for each year)
INDICATE ANY NAME OR ADDRESS CHANGE ABOVE
                                                              SCHEDULE A
FOR OFFICIAL USE ONLY                   1. Gross Reciepts per Federal Tax Return
Rec'd                                   2. Total Business Deductions
Ck. No.                                 3. Net Business income
Amount                                  4. ADD Items not deductible (Line F, Schedule B)
                                        5. Total (Line 3 plus line 4)
                                        6. DEDUCT items not subject (Line K, Schedule B)
Circle if Applicable                    7. Adjusted Net Business Income (Line 5 less Line 6)
Final Return     and/or     No Activity 8. If Sch. C from blow is used ehter Average Percentage Here
                                        9. NET PROFITS subject to License Fee (Line 7 X Line 8)
                                        10. License Fee - 1.0000% of line 9
Make checks payable and mail to:        11. Interest - 12.00% per annum portion of year.
Madison County Finance Office           12. Penalty - 5.00% per month-maxium 25%- not less than $25
        P.O. Box 547                    13. Total (Line 10+11+12)
RICHMOND, KY 40476-0547                 14. Less Credits -  ( ) ESTIMATE  ( ) OTHER
Phone Number (859) 624-4742             15. BALANCE DUE (line 13 less Line 14) pay this amount
                                        16. If estimate overpaid Indicate  (  ) Refund or (  ) Credit
                                                              SCHEDULE B
NOTE: ADD AND OR DEDUCT ONLY THOSE ITEMS WHICH ARE INCLUDED IN CALCULATING NET INCOME PER FEDERAL RETURN
             ITEMS NOT DEDUCTIBLE - ADD                                                              ITEMS NOT SUBJECT - DEDUCT
A. State or Local taxes based on income                                         G. Royalties on Patents, Copyrights
B. Capital Gain (50) subject                                                    H. Dividends
C. Net operating Loss Deduction                                                 I. Captial Loss (50% deductible)
D. Partner's Salaries (attach schedule)                                         J. Other (attach schedule)
E. Other items (please list)                                                    K. Total Deductions (enter on line 6)
F. TOTAL ADDITIONS (enter on line 4)
                                                              SCHEDULE C
             Business Allocation perecentage-Divide (Col. A) by (Col. B) to obtain decimal. Carry out at least 6 places
                             ALLOCATION FACTORS                                                                        Madison County Total Factor      Percentage
1. Total Gross Business Receipts ………………………………………………………………………………
2. Total Wages, Salaries and Other Personal Service ………………………………………………………..
3. TOTAL PERCENTS …………………………………………………………………………………………………………………………….
4. AVERAGE PERCENTAGE (Line 3 divided by number of percents) ………………………….……...Enter of line 8
         I hereby ceritfy that the information, schedules, statements and exhibits filed herewith are true and correct.

Signed                                              Title                                                              Date
THIS RETURN IS DUE ON OR BEFORE APRIL 15, FOR THE CALENDAR YEAR OR WITHIN 105 DAYS OF THE END OF YOUR FISCAL YEAR
                                                                                                                                     NP-A Rev. 5/10/2007