CITY OF OWENSBORO AND DAVIESS COUNTY FISCAL COURT 
                           APPLICATION FOR EXTENSION OF TIME 
                           TO FILE NET PROFIT LICENSE FEE RETURN 
_________________________________________________________________________________________________________ 
Name                                                                                  Occupational License Account Number/Federal ID Number 
 
___________________________________________________________________________                               Has your organization 
Number and Street or P. O. Box                                                                            currently requested an 
                                                                                                          extension of time to file 
___________________________________________________________________________                                     with the Internal 
City, State and Zip Code                                                                                        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   

 (IMPORTANT: READ INSTRUCTIONS REGARDING PAYMENTS BELOW.) 

                                                     SIGNATURE 
     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               TELEPHONE NUMBER (270) 687-5600 
                     PO BOX  10008                                                                 FAX TELEPHONE NUMBER (270) 687-8526 
                     OWENSBORO, KY 42302-9008