Jessamine County/City of Nicholasville 
                              OCCUPATIONAL LICENSE FEE ACCOUNT 
                                      BUSINESS REGISTRATION 
                                                            
               Return to:  Occupational Tax Office, 105 Court Row, Nicholasville, Kentucky 40356 
                                      (859) 885-3206 * fax (859) 887-0900 
                                                            
 The Kentucky Attorney General states that the Occupational Tax Office must make available to the public, information pertaining to the 
principal business location, address and telephone number of each person or entity (trade name – if different) and nature of business of 
                                               the person or entity filing the application. 
                                                            
 1.  Business or Trade Name  _______________________________________________________________ 
 
 2.  Local Site Address  ____________________________________________________________________ 
 
 3.  Home Address  ________________________________________________________________________ 
 
 4.  Mailing Address (if different) ______________________________________________________________ 
       If mailing address is to a tax preparer who is not an employee of your business, you must complete Lines 2 and/or 3 above. 
 
 5.     Telephone Number  ______________________  Fax Number ________________________ 
 
        Cell phone Number ______________________  Email address _______________________ 
 
 6.  Ownership 
          Sole Proprietor                             Partnership             Corporation                S Corporation 
          LLC/ Sole Proprietor                        LLC/ Partnership        LLC/ Corporation            LLC/ S Corporation 
          Non-Profit (attach exemption letter)        Other  ________________________________ 
 
 7.  Name of owner(s), partner(s), or corporate officers:  Provide names and addresses. 
     __________________________     __________________________    __________________________ 
     __________________________    ___________________________   __________________________ 
     __________________________    ___________________________   __________________________                                        
 
 8.  Social Security Number _______________________  Fed ID Number _______________________ 
 
 9.  Nature of Business _________________________________________________________________ 
      Check if applicable :   Alcohol Sales    Live Entertainment     Adult Entertainment    Hazardous Materials/Chemicals 
 
10. Date Started in Jessamine County __________________   City of Nicholasville _______________ 
 
11. Do you have employees:            Jessamine County?                 Yes   No 
                                      City of Nicholasville?            Yes   No  
 
12.  Accounting period per federal income tax return:                  Calendar Year End         Fiscal Year End  _______ 
 
13.  Do you have any other business entities in      Jessamine Co.?         Yes    No   City of Nicholasville ?    Yes            No 
        If yes, please list here ____________________________________________________________________ 
 
 I certify that, to the best of my knowledge, the above information is true and accurate and complete. 
 
________________________________                    ________________________                 __________________ 
Signature                                           Title                                    Date 
 
The Jessamine County Occupational Tax Office will administer and collect all Net Profit License Fees for the County and the 
City of Nicholasville.  If your business has employees, you will be responsible for reporting payroll and paying withholdings, 
as applicable, to the City of Nicholasville (859) 885-7618 and Jessamine County separately.