INDIVIDUAL OCCUPATIONAL LICENSE FEE RETURN
MCT FORM 4
MARION COUNTY
1.  Gross Income (including Vacation, Holiday, & Annual Leave Benefits on 
     which License fee was not deducted)                                                              $
2.  Income allocated to Marion County (from schedule below)                                           $
3.  License Fee Due (1% of Line 2)                                                                    $
4.  Interest (12% per annum of Line 3)                                                                $
5.  Failure to file or late filing of return (See Instructions)                                       $
6.  TOTAL (includes interest & penalty if due)                                                        $
Name and Address:

Social Security No. ______________________________
I hereby certify that this return has been examined by me and that the information contained herein is true, correct, and complete.
                  Signature                                                                           Date ______________
                                                   Return for Year End:
Make checks payable and mail returns to Marion County Treasurer, 223 N. Spalding Ave., Suite 201, Lebanon, KY  40033

                                       SCHEDULE OF ALLOCABLE EARNINGS
                             Enter Gross Wages, Salaries, Commissions, Including Vacation, Holiday & Annual 
                                                  Leave Benefits on Which License Fee Was Not Deducted
Employer's Name & Address                                Gross Earnings              % Marion Co.Total Allocable to Marion Co. 
                                                         (transfer total  to line 1)                  (transfer total to line 2)

                                                   Totals

                                                    INSTRUCTIONS FOR PREPARING & FILING MCT FORM 4
Persons required to file MCT FORM 4 and reportable earnings:
Individuals whose earnings within Marion County are from salaries, wages, commissions, or other compensation, received
from one or more employers, on which the Marion County License Fee was NOT deducted, must file on MCT FORM 4.  If the 
license payer has conducted a business or other activity, return must be made on MCT FORM 3.  Return on MCT FORM 4 is
made on an annual basis.  List all information in connection with your employment where the employer was not required to 
withhold the License Fee.  Earnings include salaries, wages, commissions, tips, bonuses, incentive payments, etc., whether
received directly or through an agent, and whether in cash or in property, for services rendered within Marion County for the  
appropriate period after January 1, 1986.  Board, lodging and similar items must be included as earnings at their fair market value.
An individual shall be liable to a fine as provided by ordinance for failure to file a return and/or to pay the license fee, or filing a
fraudulent return.

Date For Filing:  Individuals filing on a calender year basis must file MCT FORM 4 not later than April 15 of the following year.  Individuals
who file federal and state income tax returns on a fiscal year basis other than a calender year must file not later than the fifteenth
day of the fourth month following the end of such fiscal year.

Interest and Penalties:  Interest at the rate of 12% per annum must be paid on license fees remaining unpaid after the due date. 
Penalties of 5% per month or fraction of a month, not to exceed 25%, but not less than $25, are also on the amount of license
remaining unpaid after the due date.