OFFICIAL USE :
                                  CITY OF OAK GROVE                                                                                           
                                      P.O. BOX 250                                                                                           License # ____________________ 
                                  OAK GROVE, KY 42262                                                                                         
                                      Phone (270) 439-4646                                                                                   Invoice # ____________________ 
                                                                                               Fax   (270) 439-1201                           
                                                                                                                                             Date:       ____________________ 
                      APPLICATION FOR OCCUPATIONAL BUSINESS LICENSE                                                                           
                                  ORDINANCE #2008-05                                                                                                    
                                                      
                                  APPLICANT INFORMATION 
 
NAME OF 
APPLICANT____________________________________________________________________________________________ 
 
TRADE NAME OR DBA____________________________________________________________________________________ 
 
Mailing Address: 
 
Street___________________________________________________City_______________________________________________ 
 
State___________________________ Zip _______________ 
 
Telephone #___________________ Fax # _______________________ Email Address________________________________ 
 
Oak Grove Location (If Applicable)_____________________________________________________________________________  
 
        CHECK TYPE OF OWNERSHIP     _____Corporation ______Sole Proprietor _______Partnership _____ LLC 
 
                       CORPORATION INFORMATION 
If applicant is a corporation, please list corporate name exactly as it appears on your state and federal income tax return. 
Corporate Name ______________________________________ Date of Incorporation _________________________ 
 
                                  OWNER(S) OF BUSINESS 
If an individual, give name, date of birth, residence address, and social security number; if a partnership, give this information for each 
partner, if a corporation, give the same information for the President, Vice President, Secretary and Treasurer. 
 
                 Name                 Date of Birth                                                                                           Social Security # 
                                                                                                                                             
 List duly authorized representative of the business who is responsible for operating and managing the business in the City; 
 
Name ___________________________D.O.B.___________ SS. # ________________ Title _____________________ 
 
Residence Address_________________________________________________________________________________ 
 
Home Telephone # ________________________________________ Night Emergency # ________________________ 
 
                                  ACCOUNTING PERIOD 
 
________Calendar Year____________Fiscal Year_____/________to______/_________(please specify beginning of year) 
 

                                                  IDENTIFICATION NUMBERS 
 
   Enter any of the following identification numbers which apply to your company: 
 
    FEDERAL EMPLOYER I.D. NUMBER (The number used to file Federal Income Tax) ______________________________ 
     
    KENTUCKY STATE LICENSE # _________________________________________ 
 
               Is the applicant the owner of the premises Yes _________NO_________                           If the answer is no, give: 
 
    NAME (Premises Owner) ____________________________________ Address____________________________________ 
 
      PHONE #__________________________________________ 
 
                                         OCCUPATIONAL (PAYROLL) LICENSE FEE 
 
A.) Will you have employees working in Oak Grove?  YES _______ # Of Employees  NO ______ 
    If YES to Employees Please provide us with: 
     
    NAME _________________ ADDRESS_______________________ NAME ___________________ ADDRESS_______________________ 
 
    NAME _________________ ADDRESS_______________________ NAME ___________________ ADDRESS_______________________ 
 
    NAME _________________ ADDRESS_______________________ NAME ___________________ ADDRESS_______________________ 
 
   The City of Oak Grove has an occupational license fee of 1.5% of the gross wages paid to employees while they are working within 
   the city limits. It is the responsibility of the business owner to withhold these fees and submit them to the City of Oak Grove on a 
   quarterly basis. Forms will be provided. If you wish to have the withholding forms sent to an address other than that listed in Item 
   No. 1, please indicate below: 
 
    NAME_________________________ADDRESS _______________________________________________________ 
 
9. DATES OF BUSINESS ACTIVITY 
 
   A.) Date Business Activity began or will begin in Oak Grove: ______________________________________________________ 
    B.) Is Business in Oak Grove to be: _______  Permanent ________ Temporary 
    If temporary, give approximate dates of activity in City: ________________________to _______________________________ 
 
10. TYPE OF BUSINESS ACTIVITY 
   A. Check appropriate business classification: 
 
              __________Agriculture                                          _______________Wholesale Trade 
              __________Retail Trade                                         _______________Insurance & Real Estate 
              __________Manufacturing                                     _______________Services 
              __________Transportation & Public Utilities         ______________ Construction *
              ___________Contractors                                       * ______________ Sub-contractors *
              ___________Independent Contractors*         ______________ Motel**                             _________Restaurant**       
 
 **MOTELS HAVE A 4% TRANSIENT ROOM TAX; RESTAURANTS MUST COLLECT 3% ON ALL PREPARED FOODS. 
 
   B. Give brief description of primary business activity: 
   ________________________________________________________________________________________ 
 
NAME                                     ADDRESS                                                  PHONE 
                                                                                                   
Each business shall provide the City of Oak Grove a comprehensive list of all vendors with whom it conducts business 
within the City. This list shall be updated when the business provides the City with a tax return; as required by Section VI 
of Ordinance 2008-05 . 
               
              Name:__________________________________________________________________________ 
               

     Address:________________________________________________________________________ 
      
     City:______________ State:____________ ZIP:____________ Telephone:     
 
     Name:__________________________________________________________________________ 
      
     Address:________________________________________________________________________ 
      
     City:______________ State:____________ ZIP:____________ Telephone:     
 
     Name:__________________________________________________________________________ 
      
     Address:________________________________________________________________________ 
      
     City:______________ State:____________ ZIP:____________ Telephone:     
 
     Name:__________________________________________________________________________ 
      
     Address:________________________________________________________________________ 
      
     City:______________ State:____________ ZIP:____________ Telephone:     
 
     Name:__________________________________________________________________________ 
      
     Address:________________________________________________________________________ 
      
     City:______________ State:____________ ZIP:____________ Telephone:     
 
     Name:__________________________________________________________________________ 
      
     Address:________________________________________________________________________ 
      
     City:______________ State:____________ ZIP:____________ Telephone:     
 
11.  AMOUNT OF LICENSE FEE  
The minimum license fee due with this application is $100.00 Retail / $100.00 Professional/ $100.00 
Wholesale 
 
DENIAL TO DELINQUENT TAXPAYERS 
 
NO LICENSE WILL BE ISSUED TO ANY BUSINESS OR BUSINESS OWNER WHICH OWES THE CITY OF OAK GROVE 
ANY DELINQUENT REAL ESTATE OR TANGIBLE TAXES, ANY OCCUPATIONAL OR PAYROLL WITHHOLDING 
LICENSE FEES, ANY OTHER FEES, TAXES, OR ASSESSMENTS OF ANY KIND. 
 

        I hereby certify all information and statements herein are true and correct. 
 
        Signed   _____________________________ Date: ________________________________________ 
 
        Official Title_________________________________________________________________________ 
                                                            (Owner, Partner, Member, Treasurer, Agents, Etc.) 
 
                                                               --------------FOR OFFICIAL USE-------------- 
 
I, certify that the above named individual/ business does not owe the City of Oak Grove any delinquent real estate or tangible taxes or 
any occupational or payroll withholding license fee or any other fee, taxes or assessments of any kind. 
 
____________________________________                                                    ___________________________________ 
                     Utilities Director                                                                                            Property Tax Clerk 
                                                                                                         
____________________________________                                                   ____________________________________ 
                      City Clerk                                                                                                    Finance Director  
                                                                                                         
13. OAK GROVE BUSINESS LOCATION APPROVAL 
 
          Since your business will be located in Oak Grove, your business location must be inspected and approved by the following                   
        city departments. No license can be issued to you until your location has been approved. 
 
        X __________________________________________________________________ 
                 Planning & Zoning (270) 439-5979 
 
             X__________________________________________________________________ 
                 Building Inspector (270) 439-4646   
        
  Make checks payable to The                                    
                                                                                                                              
  City of Oak Grove. Send 
  payments to P.O. Box 250 Oak 
  Grove, KY 42262. If you want 
  to overnight a check or send 
  through UPS, FedEx, ect… 
  then our physical address is 
  8505 Pembroke Oak Grove Rd 
  Oak Grove, KY 42262.