ANNUAL RECONCILIATION OF OCCUPATIONAL LICENSE FEES WITHHELD 
                                         For the Year Ended December 31, ________ 
 
Check if Address Has Changed ____                          Federal ID No.______________               Account # _______________ 
Business Name _________________________________________________                                       Phone: (        )          -  
Address __________________________________  City________________  State_______   Zip ________ 
__________________________________________________________________________________________ 
 
1.  Total Gross Wages and Other Compensation Paid during the Year                                       $ _______________ 

2.  Less Compensation Paid for Services Performed Outside Nicholasville                                 $ _______________ 

3.  Taxable Compensation (line 1 minus line 2)                                                          $ _______________ 

4.  License Fee Due  (line 3 x 1.5%)                                                                    $  _______________ 

5.  License Fees Remitted with Quarterly Returns: 
 
     A. Quarter Ended March 31        st ____________      B. Quarter Ended June 30th           ____________                                      
      
     C. Quarter Ended September 30th____________      D. Quarter Ended December 31st____________ 
 
        Total Fees Remitted (lines A thru D)                                                            $ _______________ 
 
6. Fee Due (Refund Due)     (Line 4 minus line 5)                                                       $ _______________ 
 
7. Penalty for Failure to File or Pay On or Before February 28: 5% of the                                $ _______________ 
    license fee due for each calendar month or fraction thereof, not to exceed 25% 
    of the license fee due; however, this penalty shall not be less than $25.00 
 
8. Interest: 12% per annum simple interest on the license fee due beginning                              $ _______________ 
    from the time the fee was due.  A fraction of a month counts as an entire month 
 
 9. Total Due(Refund Due) (line 6 plus line 7 plus line 8) If any, check applicable box below           $ 
       Minor difference due to rounding only   -- No adjustment needed                                 
      Difference indicates an underpayment   -- Payment enclosed  
       Difference indicates an overpayment   -- An amended return for the period overpaid must be filed  
       separately with a letter of explanation. 
__________________________________________________________________________________________ 
 
10.  License Fees Due (from line 4 above)                                                             $ _______________ 
 
11.  Actual License Fees Withheld per Box 19 of W-2’s                                                 $ _______________ 
 
12.  Difference (line 10 minus line 11)-Please attach explanation of any difference $ _______________ 
__________________________________________________________________________________________ 
The original of this reconciliation along with a copy of the W-2’s must be filed with the City of Nicholasville on or 
                       th
before February 28  to the following address:    
                      City of Nicholasville, P.O. Box 590, Nicholasville, KY  40340-0590 
                      Telephone: (859) 885-7618  Fax (859) 885-9476 
I hereby certify that this information is true and correct to the best of my knowledge. 
 
Signature                                                                                       Date                                                
 
Print Name                                                                                      Title 
                                                              Revised 12/8/15