CITY OF OWENSBORO AND DAVIESS COUNTY FISCAL COURT
                           APPLICATION FOR EXTENSION OF TIME
                           TO FILE NET PROFIT LICENSE FEE RETURN

NAME:                                                                          ACCOUNT NUMBER OR FEDERAL ID NUMBER:

ADDRESS:                                                                       Has your organization currently requested an 
                                                                                extension of time to file with the Internal 
                                                                                       Revenue Service?
                                                                                       YES     NO  

An automatic 6 month extension of time is hereby requested to file the Net Profit License Fee Return  of the organization
named above for the taxable year beginning ___________________ and  ending _____________________.  (Extension
cannot be granted for more than 6 months.)

State in detail the reason the extension of time to file is needed:

         $                                                                     $
             CITY OF OWENSBORO                                                         DAVIESS COUNTY
      (Minimum Annual License Fee $75.00)

         (IMPORTANT:  READ INSTRUCTIONS REGARDING PAYMENTS BELOW.)

Under penalties of perjury, I declare that I am authorized to make this application for the above named organization, and that to the best
of my knowledge and belief the statements made herein are true, correct and complete.

           Signature and phone number     Title                                        Date

INSTRUCTIONS:

PAYMENTS:  Any payment made with the extension request must specifically identify the amount being paid on behalf of each jurisdiction.
If the payment breakdown is not specified the Occupational Tax Administrator will determine allocation to the account.  Overpayment
of license fee to the City of Owensboro will not be allowed to offset any underpayment of license fee to Daviess County.  Overpayment of
license fee to Daviess County will not be allowed to offset any underpayment of license fee to the City of Owensboro.

DUE DATE:  The Occupational Tax Administrator  has the authority to extend the time for filing the net profit license fee return, provided
the extension request is made on or before the required due date of the return.

INTEREST:  If the Occupational Tax Administrator grants an extension of time for filing a return, any balance  unpaid when payment is due,
without regard to extension granted, shall bear interest at the rate of one (1) percent per calendar month or fraction of month.

UNTIMELY REQUEST:  An extension will be granted for a request received after the original due date of the return; however, penalties will be
assessed from the due date of the return to the date the extension request is received.

LENGTH OF EXTENSION:  No single extension of time for filing a net profit license fee return shall be granted for more than six (6) months
from the original due date.

MAIL TO: OCCUPATIONAL TAX ADMINISTRATOR
         PO BOX 10008                                                          PHONE NUMBER (270) 687-5600
         OWENSBORO KY  42302-9008                                              FAX NUMBER (270) 687-8526