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CITY OF OWENSBORO AND DAVIESS COUNTY FISCAL COURT (FOR PERIODS ENDING AFTER
EMPLOYER’S AMENDED RETURN OF LICENSE FEE WITHHELD 6/30/05 ONLY)
NAME AND ADDRESS AND PHONE NUMBER
Account No.:
Period Beginning:
Period Ending:
Due Date:
Type:

PART I (COMPLETE PART II ON BACK) I II III
As Originally Net Change
WAGE INFORMATION: FROM FORM EQ-1 Reported or Adjusted Increase or Decrease Correct Amount
TOTAL GROSS WAGES, SALARIES AND OTHER
COMPENSATION PAID:
1A. City of Owensboro……………………………………

1B. Daviess County……………………………………….
LESS COMPENSATION NOT SUBJECT TO
LICENSE FEE:
2A. City of Owensboro……………………………………

2B. Daviess County……………………………………….
EARNINGS SUBJECT TO LICENSE FEE:
3A. City of Owensboro (Line 1A minus Line 2A)………

3B. Daviess County (Line 1B minus Line 2B)…………...
LICENSE FEE DUE:
4A. City of Owensboro (1.33% of Line 3A)……………..

4B. Daviess County (.35% of Line 3B for periods ending
after 12/31/06; .5% for periods before 01/01/07)
PENALTY: (5% per calendar month not to exceed 25%,
$25 minimum)
5A. City of Owensboro…………………………...............

5B. Daviess County……………………………………….
INTEREST: (1% per calendar month or fraction thereof)
6A. City of Owensboro…………………………...............

6B. Daviess County………………………………………
TOTAL AMOUNT DUE:
7A. City of Owensboro (Add Lines 4A, 5A and 6A)……

7B. Daviess County (Add Lines 4B, 5B and 6B)………..

PAYMENTS AND CREDITS
LICENSE FEE, INTEREST AND PENALTY PAID WITH ORIGINAL RETURN:
8A. City of Owensboro……………………………………………………………………………………….

8B. Daviess County…………………………………………………………………………………………
PAYMENTS OR CREDITS NOT CLAIMED ON THE ORIGINAL RETURN:
9A. City of Owensboro……………………………………………………………………………………….

9B. Daviess County…………………………………………………………………………………………
TOTAL PAYMENTS AND CREDITS:
10A. City of Owensboro (Line 8A plus Line 9A)…………………………………………………………...

10B. Daviess County (Line 8B plus Line 9B)………………………………………………………………..
Continued on Back

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REFUND OR AMOUNT DUE 
 
    REFUND OR CREDIT, IF ANY, SHOWN ON ORIGINAL RETURN:                                                     
       11A. City of Owensboro……………………………………………………………………………………                                               
                                                                                                            
       11B. Daviess County………………………………………………………………………………………                                                 
     TOTAL ADJUSTED CREDITS:                                                                                
       12A. City of Owensboro (Line 10A minus Line 11A)……………………………………………………… 
                                                                                                            
       12B. Daviess County (Line 10B minus Line 11B)………………………………………………………….. 
     TOTAL AMOUNT DUE:                                                                                      
        13A. City of Owensboro  : If Line 7A of Column III is more than line 12A, enter the amount due………. 
                                                                                                            
        13B. Daviess County:  If Line 7B of Column III is more than Line 12B, enter the amount due………… 
    TOTAL REFUND DUE:                                                                                       
       14A. City of Owensboro: If Line 7A of Column III is less than Line 12A, enter the refund due…………. 
                                                                                                            
       14B. Daviess County: If Line 7B of Column III is less than Line 12B, enter the refund due……………... 
 
PART II 
 
Give a brief explanation why this amended return is being filed. 
_______________________________________________________________________________________________________ 
 
_______________________________________________________________________________________________________ 
 
_______________________________________________________________________________________________________ 
 
_______________________________________________________________________________________________________ 
 
_______________________________________________________________________________________________________ 
 
I, the undersigned, declare under penalties of perjury that I have examined this return, including all accompanying schedules and 
statements, and to the best of my knowledge and belief, it is true, correct and complete. 
 
___________________________________                     _____________                    _________________________________ 
Signature of Return Preparer                                                           Date                              Signature of License Fee Payer 
 
STATUE OF LIMITATIONS 
No refund shall be made on a filed return two (2) years after the date the overpayment is made. 
 
MAIL TO: OCCUPATIONAL TAX ADMINISTRATOR 
                   PO BOX 10008 
                   OWENSBORO, KY  42302-9008 
                   TELEPHONE NUMBER:  (270) 687-5600 
      www.owensboro.org

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INSTRUCTIONS:

PART I

Line 1A City of Owensboro
Column I – Enter Gross wages, Salaries and other Compensation as originally reported on Form EQ-1.
Column III – Enter Gross wages, Salaries and other Compensation as amended.
Column II – Enter the net increase or decrease of gross wages, salaries and other compensation.

Line 1B Daviess County
Column I – Enter Gross wages, Salaries and other Compensation as originally reported on Form EQ-1.
Column III – Enter Gross wages, Salaries and other Compensation as amended.
Column II – Enter the net increase or decrease of gross wages, salaries and other compensation.

Line 2A City of Owensboro
Column I- Enter compensation not subject to the license fee as originally reported on Form EQ-1.
Column III- Enter compensation not subject to the license fee as amended.
Column II - Enter the net increase or decrease of compensation not subject to the license fee.

Line 2B Daviess County
Column I- Enter compensation not subject to the license fee as originally reported on Form EQ-1.
Column III- Enter compensation not subject to the license fee as amended.
Column II - Enter the net increase or decrease of compensation not subject to the license fee.

Line 3A City of Owensboro
Column I – Enter earnings subject to license fee as originally reported. Line 1Aminus Line 2A.
Column III – Enter earnings subject to license fee as amended. Line 1A minus Line 2A.
Column II – Enter the net increase or decrease of earnings subject to the license fee.

Line 3B Daviess County
Column I – Enter earnings subject to license fee as originally reported. Line 1B minus Line 2B.
Column III – Enter earnings subject to license fee as amended. Line 1B minus Line 2B.
Column II – Enter the net increase or decrease of earnings subject to the license fee.

Line 4A City of Owensboro
Column I – Enter license fee due as originally reported.
Column III – Enter license fee due as amended. Multiply Line 3A by 1.33%.
Column II – Enter the net increase or decrease of license fee due.

Line 4B Daviess County
Column I – Enter license fee due as originally reported.
Column III – Enter license fee due as amended. Multiply Line 3A by applicable rate.
Column II – Enter the net increase or decrease of license fee due.

Line 5A City of Owensboro
Column I – Enter penalty as originally reported. Any licensee who fails to file and/or pay the license fee by the due date
shall pay penalty at the rate of 5% per calendar month, not to exceed 25% of the total license fee due,
however, the penalty will always be a minimum of $25. Multiply applicable percentage by Line 4A.
Column III – Enter penalty due on the amended license fee due. Any licensee who fails to file and/or pay the license fee by
the due date shall pay penalty at the rate of 5% per calendar month, not to exceed 25% of the total license
fee due, however, the penalty will always be a minimum of $25. Multiply applicable percentage by Line 4A.
Column II – Enter the net increase or decrease of penalty.

Line 5B Daviess County
Column I – Enter penalty as originally reported. Any licensee who fails to file and/or pay the license fee by the due date
shall pay penalty at the rate of 5% per calendar month, not to exceed 25% of the total license fee due,
however, the penalty will always be a minimum of $25. Multiply applicable percentage by Line 4B.
Column III – Enter penalty due on the amended license fee due. Any licensee who fails to file and/or pay the license fee
by the due date shall pay penalty at the rate of 5% per calendar month, not to exceed 25% of the total license
fee due, however, the penalty will always be a minimum of $25. Multiply applicable percentage by Line 4B.
Column II – Enter the net increase or decrease of penalty.

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Line 6A City of Owensboro
Column I – Enter interest as originally reported. Any licensee who fails to pay the license fee by the due date shall pay
interest at the rate of 1% per calendar month, or fraction thereof, of any license fee due. Multiply Line 4A by
applicable percentage.
Column III – Enter interest due on the amended license fee due. Any licensee who fails to pay the license fee by the due
date shall pay interest at the rate of 1% per calendar month, or fraction thereof, of any license fee due.
Multiply Line 4A by applicable percentage.
Column II – Enter the net increase or decrease of interest.

Line 6B Daviess County
Column I – Enter interest as originally reported. Any licensee who fails to pay the license fee by the due date shall pay
interest at the rate of 1% per calendar month, or fraction thereof, of any license fee due. Multiply Line 4B by
applicable percentage.
Column III – Enter interest due on the amended license fee due. Any licensee who fails to pay the license fee by the due
date shall pay interest at the rate of 1% per calendar month, or fraction thereof, of any license fee due.
Multiply Line 4B by applicable percentage.
Column II – Enter the net increase or decrease of interest.

Line 7A City of Owensboro
Column I – Enter total amount due as originally reported. Add Lines 4A, 5A and 6A.
Column III – Enter total amount due as amended. Add Lines 4A, 5A and 6A.
Column II – Enter the net increase or decrease of the total amount due.

Line 7B Daviess County
Column I – Enter total amount due as originally reported. Add Lines 4B, 5B and 6B.
Column III – Enter total amount due as amended. Add Lines 4B, 5B and 6B.
Column II – Enter the net increase or decrease of the total amount due.

Line 8A City of Owensboro – Enter the amount of license fee, interest and penalty paid with original return.

Line 8B Daviess County – Enter the amount of license fee, interest and penalty paid with the original return.

Line 9A City of Owensboro – Enter any existing payments or credits not claimed on the original return.

Line 9B Daviess County – Enter any existing payments or credits not claimed on the original return.

Line 10A City of Owensboro – Enter total payments and credits. Line 8A plus Line 9A.

Line 10B Daviess County – Enter total payments and credits. Line 8B plus Line 9B.

Line 11A City of Owensboro – Enter refund or credit, if any, shown on original return.

Line 11B Daviess County – Enter refund or credit, if any, shown on original return.

Line 12A City of Owensboro – Enter adjusted credits. Line 10A minus Line 11A.

Line 12B Daviess County – Enter adjusted credits. Line 10B minus Line 11B.

Line 13A City of Owensboro – If Line 7A of Column III is more than Line 12A, enter the amount due.

Line 13B Daviess County – If Line 7B of Column III is more than Line 12B, enter the amount due.

Line 14A City of Owensboro– If Line 7A of Column III is less than Line 12A, enter the refund due. No refund is issued under $5.00.

Line 14B Daviess County – If Line 7B of Column III is less than Line 12B, enter the refund due. No refund is issued under $5.00.

PART II

Give a brief explanation why the amended return is being filed.

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