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                                                                                                                                                 For Periods Ending 
                                                                  CITY OF OWENSBORO                                                              After 6/30/17 ONLY
                                                                OCCUPATIONAL LICENSE FEE
                                                    ANNUAL INDIVIDUAL EMPLOYEE RETURN
                   EMPLOYEE NAME                                                                               EMPLOYED BY

    Year Ending    ADDRESS
                                                                                                               SOCIAL SECURITY NUMBER
                   CITY, STATE, ZIP CODE

    Account Number PHONE NUMBER                                                                                Check here if employed by Federal 
                                                                                                               or State Government

                                                    PLEASE READ INSTRUCTIONS BEFORE COMPLETING THIS RETURN

                                                                                SECTION A

1.  Gross Employee Compensation per Medicare Wage Box of attached W-2(s).  (add Section 125 "Cafeteria Plan Benefits" received
    after 6/3/05 and other subject benefits not included in Medicare Wage box on W-2(s).  A copy of your final paystub for the year
    must also be attached)
2.  Total hours/days worked everywhere during the year to earn compensation on Line 1 (Exclude hours/days for holiday,
    vacation, and sick pay benefits paid to you while absent from work)
3.  Total hours/days worked in the City of Owensboro during the year. (Complete Form 200-VO on back) (Exclude hours/days for 
    holiday, vacation, and sick pay benefits paid to you while absent from work)

4.  Percentage of hours/days worked in Owensboro (line 3 divided by line 2) (Carry out four places)

5.  Compensation Subject to License Fee (Line 4 X Line 1)

6.  Occupational License Fee Rate (see instructions)

7.  Occupational License Fee Due (Line 6 X Line 5)

8.  Total License Fee Paid During the Year or Withheld for the City of  Owensboro As Shown On Attached W-2(s)

9.  If Line 8 is Greater than Line 7, Enter Difference as REFUND
10. Enter any portion of refund from Line 9 above to be applied to Current Year Daviess County License Fee Due (Also enter this
    amount on Line 13 of the Daviess County Individual Employee Return)

11. Adjusted Refund (Line 9 minus Line 10)

12. If Line 7 is greater than line 8, enter the difference as LICENSE FEE DUE
13. Amount of Daviess County License Fee Overpayment from Line 10 of the Daviess County Individual Employee Return to be credited
    against City of Owensboro License Fee due on Line 12 above

14. Adjusted License Fee Due (Line 12 minus Line 13)

15. Penalty @ 5% per calendar month not to exceed 25%  $25 MINIMUM

16. Interest @ 1% per calendar month or fraction thereof

17. Total Due (Add Lines 14, 15 and 16)

I hereby certify that the statements made herein and in any supporting schedule are true, correct and complete to the best of my knowledge.

    Signature of Employer                                                       Date                           Signature of Employee             Date

                                                    RETURN MUST BE SIGNED

              MAIL TO: OCCUPATIONAL TAX ADMINISTRATOR
                       PO BOX 10008
                       OWENSBORO KY  42302
                       (270) 687-5600                                                                                                            FORM RU-1



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                                                              DAVIESS COUNTY FISCAL COURT
                                                                    OCCUPATIONAL LICENSE FEE
                                                    ANNUAL INDIVIDUAL EMPLOYEE RETURN
                   EMPLOYEE NAME                                                                                           EMPLOYED BY

    Year Ending    ADDRESS
                                                                                                                           SOCIAL SECURITY NUMBER
                   CITY, STATE, ZIP CODE

    Account Number PHONE NUMBER                                                                                            Check here if employed by Federal 
                                                                                                                           or State Government

                                                     PLEASE READ INSTRUCTIONS BEFORE COMPLETING THIS RETURN

                                                                                SECTION A

1.  Gross Employee Compensation per Medicare Wage Box of attached W-2(s).  (add Section 125 "Cafeteria Plan Benefits" received
    after 6/3/05 and other subject benefits not included in Medicare Wage box on W-2(s).  A copy of your final paystub for the year
    must also be attached)
2.  Total hours/days worked everywhere during the year to earn compensation on Line 1 (Exclude hours/days for holiday,
    vacation, and sick pay benefits paid to you while absent from work)
3.  Total hours/days worked in Daviess County during the year. (Complete Form 200-VO on back) (Exclude hours/days for 
    holiday, vacation, and sick pay benefits paid to you while absent from work)

4.  Percentage of hours/days worked in Daviess County (line 3 divided by line 2) (Carry out four places)

5.  Compensation Subject to License Fee (Line 4 X Line 1)

6.  Occupational License Fee Rate                                                                                                                                     0.35%

7.  Occupational License Fee Due (Line 6 X Line 5)

8.  Total License Fee Paid During the Year or Withheld for Daviess County As Shown On Attached W-2(s)

9.  If Line 8 is Greater than Line 7, Enter Difference as REFUND
10. Enter any portion of refund from Line 9 above to be applied to Current Year City of Owensboro License Fee Due (Also enter this 
    amount on Line 13 of the City of Owensboro Individual Employee Return)

11. Adjusted Refund (Line 9 minus Line 10)

12. If Line 7 is greater than line 8, enter the difference as LICENSE FEE DUE
13. Amount of City of Owensboro License Fee Overpayment from Line 10 of the City of Owensboro Individual Employee Return to be 
    credited against Daviess County License Fee due on Line 12 above

14. Adjusted License Fee Due (Line 12 minus Line 13)

15. Penalty @ 5% per calendar month not to exceed 25%  $25 MINIMUM

16. Interest @ 1% per calendar month or fraction thereof

17. Total Due (Add Lines 14, 15 and 16)

I hereby certify that the statements made herein and in any supporting schedule are true, correct and complete to the best of my knowledge.

    Signature of Employer                                                                                             Date Signature of Employee                      Date

                                                    RETURN MUST BE SIGNED

              MAIL TO: OCCUPATIONAL TAX ADMINISTRATOR
                       PO BOX 10008
                       OWENSBORO KY  42302
                       (270) 687-5600                                                                                                                        FORM RU-1



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       FORM 200-VO
       CALCULATION OF WAGES EARNED OUTSIDE THE CITY OF OWENSBORO

       Schedule of Days/Hours Spent Working Outside the City of Owensboro

     If additional space is needed, use photocopies of this page.  Make sure you attach all pages to the Individual
       Employee Return.

NOTE:  a)  Schedule must be based upon actual working time.  DO NOT use commissions, mileage etc.

     b)  Any time spent working (preparing reports, making business related telephone calls, etc.) from your
           City of Owensboro home or office is considered time inside the City of Owensboro.

DATE   LOCATION                                                                             DAYS/HOURS

                                                                   TOTAL this page
                                                             TOTAL other pages

                                                                   GRAND TOTAL



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       FORM 200-VO
       CALCULATION OF WAGES EARNED OUTSIDE DAVIESS COUNTY

       Schedule of Days/Hours Spent Working Outside Daviess County

     If additional space is needed, use photocopies of this page.  Make sure you attach all pages to the Individual
       Employee Return.

NOTE:  a)  Schedule must be based upon actual working time.  DO NOT use commissions, mileage etc.

     b)  Any time spent working (preparing reports, making business related telephone calls, etc.) from your
            Daviess County home or office is considered time inside Daviess County.

DATE   LOCATION                                                                    DAYS/HOURS

                                                                   TOTAL this page
                                                             TOTAL other pages

                                                                   GRAND TOTAL



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                                                 GENERAL INFORMATION 
The ANNUAL INDIVIDUAL EMPLOYEE RETURN is required to be filed by any employee, who during the calendar 
year, failed to remit through employer withholding or other payment means, the correct amount of Occupational License 
Fee due to the City of Owensboro and/or Daviess County Fiscal Court. For purposes of calculating the Occupational 
License Fee due, compensation earned by an employee as a result of time spent providing services within the corporate 
city limits of Owensboro shall be considered when determining the Occupational License Fee due the City of Owensboro. 
Compensation earned by an employee as a result of time spent providing services within Daviess County, occurring 
outside the corporate city limits of Owensboro, shall be considered when determining the Occupational License Fee due 
Daviess County. If it is impossible to apportion the employee earnings on time spent because of the peculiar nature of the 
services of the employee, or of the unusual basis of compensation, apportionment shall be made for both the City of 
Owensboro and/or Daviess County in accordance with the facts. With respect to an employee who determines that 
compensation cannot be accurately measured by time spent, such employee shall furnish with the Individual Employee 
Return a detailed statement of the facts providing a clear and concise explanation of the circumstances under which 
compensation is paid to the employee. For any underpayment of license fee by the employee, this return must be filed 
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and the fee paid by the 15  day of the fourth month following the end of the calendar year for which the additional 
license fee is due. After that date applicable penalty and interest will be assessed. 
    
THERE IS A TWO-YEAR STATUTE OF LIMITATIONS within which a request for refund must be submitted to the 
City of Owensboro and/or Daviess County. A refund request made by an employee who has compensation attributable to 
activities outside either jurisdiction, but whose employer has withheld and remitted the occupational license fee to the 
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jurisdiction(s), must be postmarked within 2 years of the 15  day of the fourth month following the end of the calendar 
year for which a refund is due.  
 
ANY REFUND OF OCCUPATIONAL LICENSE FEE DUE THE EMPLOYEE WILL BE MAILED DIRECTLY 
TO THE EMPLOYER at the last known address, unless there is submitted with the return a signed request from the 
employer to mail the refund directly to the employee. The employee must complete the appropriate parts of the return and 
both the employee and employer must sign the form or any request for refund will not be honored. A 1099-G form will be 
issued to all employees at the end of the tax year on any refund over ten dollars ($10.00) that is mailed directly to the 
employee.  
 
REQUIRED INFORMATION NEEDED FOR A REFUND TO BE ISSUED 
    •      Separate return for each employee for each year involved. 
    •      If employee is due a refund as a result of working for more than one employer, a separate return must be 
           completed by the employee to claim the refund for each employer who incorrectly withheld the license fee. 
    •      Copy of the applicable W-2(s) must be attached to each return filed.  
    •      Copy of final pay stub for the year. 
    •      Signature of employee verifying that all information on the document is correct. 
    •      Signature of employer verifying that all information is correct. 
 
           INSTRUCTIONS FOR COMPLETION OF THE ANNUAL INDIVIDUAL EMPLOYEE RETURN 
 
Line 1  Enter the Total Gross Wages per the Medicare Wage box of W-2(s), including deferred compensation, Section 
           125 “Cafeteria Plan Benefits,” and other subject benefits not included in the Medicare Wage box. 
            
Note:  The employee filing a return for the City of Owensboro should be aware that Section 125 “Cafeteria Plan 
           Benefits” only became subject to the City of Owensboro Occupational License Fee effective with     
           employee compensations paid on or after July 1, 2005.  
 
Line 2 Enter the total hours/days worked everywhere during the year to earn the compensation reported on Line 1. (For    
           example: 40 hours x 52 weeks = 2,080 hours worked per year. This number may vary based on overtime or due to 
           working more or less than a standard five day work week. Total hours/days worked per year should exclude         
           vacation, sick and holiday benefits.  
 
Line 3 City of Owensboro: 
           Enter the total hours/days worked in the City of Owensboro during the year. Total hours/days worked in the       
           City of Owensboro should exclude vacation, sick and holiday benefits. Failure to complete any and all parts     
           Form 200-VO will delay the processing of your refund. 
 
             Daviess County: 



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   Enter the total hours/days worked in Daviess County, outside the City of Owensboro, during the year.                      
   Total hours worked in Daviess County should exclude vacation, sick and holiday benefits. Note: An employee    
   filing a return specifically for the year ending 12/31/05 is only subject to the provisions of the Daviess                
   County Occupational tax beginning 07/01/05. In determining the total hours/days worked in                       
   Daviess County during the year, the filer should calculate the hours/days worked in Daviess County                        
   only for the time period 07/01/05 through 12/31/05. Failure to complete any and all parts of Form 200-VD     
   will delay the processing of your refund. 
 
Line 4    Enter the percentage of hours worked as applicable. (Line 3 divided by Line 2) 
 
Line 5    Calculate the compensation subject to license fee. (Multiply Line 4 by Line 1). 
 
Line 6    Applicable occupational license fee rate for jurisdiction. 
          CITY OF OWENSBORO SEE TABLE / DAVIESS COUNTY .35% 
                                 YEAR                               RATE 
                          2014                     1.33% 
                          2015                     1.36% (split rate) 
                          2016                     1.39% 
                          2017                     1.59% (split rate) 
                          2018                     1.78% 
 
Line 7    Calculate the occupational license fee due. (Multiply Line 6 by Line 5) 
 
Line 8    Applicable jurisdiction(s) license fee paid or withheld as shown on W-2(s). 
 
Line 9    If Line 8 is greater than Line 7, enter the difference as Refund. 
 
Line 10  City of Owensboro: 
          Enter any amount of the refund from Line 9 to be applied against Daviess County Occupational License Fee 
          Due on the current year Individual Employee Return. Also enter this amount on Line  13 of the current year  
          Daviess County Individual Employee Return. 
 
          Daviess County: 
          Enter any amount of the refund from Line 9 to be applied against City of Owensboro Occupational License Fee 
          Due on the current year Individual Employee Return. Also enter this amount on Line  13 of the current year 
          City of Owensboro Individual Employee Return. 
 
Line 11   Enter the adjusted refund. (Line 9 minus Line 10). 
 
Line 12   If Line 7 is greater than Line 8, enter the difference as License Fee Due. 
 
Line 13  City of Owensboro: 
          Enter the amount of Daviess County License Fee Overpayment from Line 10 of the Daviess County 
          Individual Employee Return to be credited against the City of Owensboro license fee due on Line 12. 
          Daviess County: 
          Enter the amount of City of Owensboro License Fee Overpayment from Line 10 of the City of  Owensboro 
          Individual Employee Return to be credited against the Daviess County License Fee due on Line 12. 
 
Line 14   Adjusted License Fee Due. (Line 12 minus Line 13) 
 
Line 15   Applicable percentage of penalty multiplied by Line 14. Any employee who fails to file and/or pay any 
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          underpayment of license fee due by the 15  day of the fourth month following the close of a calendar year, 
          shall pay penalty at the rate of 5% per calendar month, not to exceed 25% of the total license fee due, however 
          penalty will always be a minimum of $25. 
 
Line 16   Applicable percentage of interest multiplied by Line 14. Any employee who fails to pay the license fee due by 
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          the 15  day of the fourth month following the close of a calendar year, shall pay interest at the rate of 1% per 
          calendar month or fraction thereof, of any license fee due. 
 
Line 17   Total License Fee Due. (Add Lines 14, 15 and 16)   






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