| MARION COUNTY, KENTUCKY | |||||||||||
| 223 N. SPALDING AVE., ROOM 201, LEBANON, KY 40033 | |||||||||||
| MCT FORM 3 | (Please Review Instruction Sheet Before Completion) | LICENSE FEE RETURN | |||||||||
| BUSINESS NAME | CALENDER OR FISCAL YEAR ENDED | ||||||||||
| MONTH | DAY | YEAR | |||||||||
| STREET ADDRESS | |||||||||||
| FEDERAL TAX ID OR SSN | |||||||||||
| CITY | STATE | ZIP CODE | |||||||||
| COMPUTATION OF LICENSE FEE | |||||||||||
| 1. Net Profits Subject to License Fee (Enter Line 7, Schedule A, Page 2.)……………..…………………….. | ……………. | …………….…….. | $ | ||||||||
| 2. Marion County License Fee @ 1%........................................................................................................... | …………… | ……………. | …………….. | …………….. | …………..…….. | $ | |||||
| 3. Interest @ 12% per annum………………………..……………………………………………………………. | ……………. | ……………. | …………… | ……………. | ……………..….. | $ | |||||
| 4. Penalty @ 5% per month or fraction of month (not to exceed 25%, minimum $25)……………………………..………………………………… | ……………...….. | $ | |||||||||
| 5. Total (Items 2, 3, and 4)…………………...…………………………………………………………………….. | …………… | ……………… | …………….. | ……………. | …………….….. | $ | |||||
| 6. Less Credits for Estimates/Extension Payments………………………………………………. | ……………. | ……………… | …………… | …………….….. | $ | ||||||
| 7. Balance Due……………………...………………………………………………………………………………. | ……………… | ……………. | ……………. | ……………. | ……………. | ……………….... | $ | ||||
| QUESTIONS (ANSWER FULLY) | |||||||||||
| 1. Check Which: □ Corporation, □ Partnership, □ Individual Owner, □ Fidiciary, □ Other (State)____________________________________ | |||||||||||
| 2. Nature of Business (Trade)___________________________________________________________________________________________ | |||||||||||
| 3. Date Business Started or Trust Created_________________________________________________________________________________ | |||||||||||
| 4. If Organization was Discontinued, State Whether by Dissolution______________________________ or Sale__________________________ | |||||||||||
| If by sale, give Name & Address of Successor Organization_________________________________________________________________ | |||||||||||
| _________________________________________________________________________________________________________________ | |||||||||||
| 5. Did you have any Employees in Marion County during the taxable year? □ Yes □ No | |||||||||||
| 6. Has the Marion County License Fee been withheld from All Subject Employees and Remitted Quarterly in accordance with Regulations? | |||||||||||
| □ Yes □ No, Explain_______________________________________________________________________________________________ | |||||||||||
| 7. Has Return of Info. for Each Employee, as Per the Regulations Been Forwarded to the License Fee Division? □ Yes □ No | |||||||||||
| 8. Check Whether this Return is prepared on Cash _______________ or Accrual _______________ Basis. | |||||||||||
| 9. Show Name and Address of each place of Business operated Subject to Marion County License Fee and check if not included in this return. | |||||||||||
| Not Included | |||||||||||
| I HEREBY CERTIFY THAT THE STATEMENTS MADE HEREIN AND IN ANY SUPPORTING SCHEDULES ARE TRUE, CORRECT AND COMPLETE | |||||||||||
| TO THE BEST OF MY KNOWLEDGE. | |||||||||||
| / / | / / | ||||||||||
| Signature of Individual Preparing Return | Date | Signature of Taxpayer | Date | ||||||||
| THIS RETURN MUST BE FILED AND PAID IN FULL ON OR BEFORE APRIL 15, OR WITHIN 105 DAYS AFTER CLOSE OF FISCAL YEAR. | |||||||||||
| PER ORDINANCE 05-220.10, SUBMIT A COPY OF SUPPORTING FEDERAL INCOME TAX RETURN ALONG WITH THIS RETURN. | |||||||||||
| Make Check Payable To: MARION COUNTY TREASURER | |||||||||||
| Mail To: MARION COUNTY TREASURER, 223 N. SPALDING AVE., ROOM 201, LEBANON, KY 40033 | |||||||||||
| MCT FORM 3, PAGE 2 | |||||||||||
| SCHEDULE A | |||||||||||
| Computation of Net Profits Subject to License Fee | |||||||||||
| 1. Net Income Per Federal Return, Form 1040________; 1041________; 1065________; 1120________..................... | ………….. | $ | . | ||||||||
| 2. Add Items Not Deductible Under License Fee Ordinance (Schedule B)………………………………………………….. | ……………. | ……………. | ………….. | $ | . | ||||||
| 3. Total (Line 1 plus Line 2)………………………………………………………………………………………………………. | ……………. | …………….. | ……………. | …………… | …………….. | ………….. | $ | . | |||
| 4. Deduct Item Not Subject Under License Fee Ordinance (Schedule B)…………………………………………………… | ……………. | ……………… | ………….. | $ | . | ||||||
| 5. Adjusted Income for Calender Year 20____ or Fiscal Year Ending ________________............................................. | ……………. | ………….. | $ | . | |||||||
| 6. Percent (As Determined by Schedule C)…………………………………………………………………………………….. | …………… | …………… | …………… | ……………. | ………….. | % | |||||
| 7. Net Profits Subject to Marion County License Fee - Enter as Item 1, Page 1……………………………………………………. | ……………… | ……………. | ………….. | $ | . | ||||||
| SCHEDULE B | |||||||||||
| Adjustment of Net Profit for Federal Tax Purposes to Provisions of Marion County License Fee Ordinance | |||||||||||
| 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 | G. Interest on Corporate Bonds | ||||||||||
| Income | $ | . | $ | . | |||||||
| B. License Fee under this Ordinance | H. Interest on U.S. Government | ||||||||||
| $ | . | Securities | $ | . | |||||||
| C. Net Operating Loss Deduction | I. Royalties on Patents, Copyrights | ||||||||||
| $ | . | $ | . | ||||||||
| D. Partners Salaries (attach schedule) | J. Dividends | ||||||||||
| $ | . | $ | . | ||||||||
| E. Other items (list) | K. Capital Loss | ||||||||||
| $ | . | $ | . | ||||||||
| L. Other items (list) | |||||||||||
| $ | . | $ | . | ||||||||
| $ | . | $ | . | ||||||||
| F. Total Additional | M. Total Deductions | ||||||||||
| (Enter as Line 2, Schedule A) | $ | . | (Enter as Line 4, Schedule A) | $ | . | ||||||
| SCHEDULE C | |||||||||||
| Business Allocation Percentage Formula | |||||||||||
| Divide (A) by (B) to obtain Decimal - Carry Out Decimal at Least 6 Places | |||||||||||
| ALLOCATION FACTORS | Column 1 | Column 2 | Column 3 | ||||||||
| Marion County Factor (A) | Total Factor (B) | Percentage | |||||||||
| 1. Gross Sales of Merchandise, Less Returns and Allowance (Do Not Include | |||||||||||
| Include Discounts Allowed) | $ . | $ . | |||||||||
| Charges for Work or Service Performed | $ . | $ . | |||||||||
| Other Income | $ . | $ . | |||||||||
| Total Business Receipts Factor | $ . | $ . | % | ||||||||
| 2. Wages, Salaries, and Other Personal Service Compensation | $ . | $ . | |||||||||
| Total Net Wages Factor | $ . | $ . | % | ||||||||
| 3. Total Percents | % | ||||||||||
| 4. Average Percentage (Carry Percentage in Col 3 to Line 6, Schedule A) | % |