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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 _______________________________________________________
Check if mailing address is to a tax preparer which is not an employee of your business. If so, you must complete Lines 2 and/or 3 above.
5) Telephone Number _____________________ Fax ___________________________
6) Cell Phone Number ____________________ E-mail address___________________
7) Ownership
Sole Proprietor Partnership Corporation S Corporation
LLC/sole prop LLC/partnership LLC/Corporation LLC/S Corporation
Non-Profit (Attach exemption letter) Other ___________________
8) Name of owner(s), partner(s) or corporate officers
_____________________ _______________________ _______________________
Name Name Name
_____________________ _______________________ _______________________
Address Address Address
__________________________ ____________________________ ____________________________
9) Social Security Number ______________________ Fed ID # _____________________
10) Nature of Business ________________________________________________________
Check if applicable to above business Alcohol Sales Live Entertainment Adult Entertainment
11) Date Started in Jessamine Co ____________ City of Nicholasville ______________
12) Do you have employees? Jessamine County Yes No
City of Nicholasville Yes No
13) Accounting period per federal income tax return Calendar Year
Fiscal Year End ______
14) Do you have any other business entities in Jessamine County? Yes No
Nicholasville ? Yes No
*If yes, please list them here ____________________________________________________
I certify that, to the best of my knowledge, the above information is true, accurate and complete.
______________________________ _______________________ ______________
Signature Title Date
The Jessamine County Occupational Tax Office will administer and collect all Net Profit License Fee Returns for the
County and the City of Nicholasville. If your business has employees, you will be responsible for reporting payroll
and paying withholdings to the City of Nicholasville (859)885-7618 and Jessamine County separately.
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