THE CITY OF PADUCAH 

             ANNUAL RECONCILIATION OF EMPLOYERS QUARTERLY RETURN 
 OF OCCUPATIONAL LICENSE FEES WITHHELD AND INDIVIDUAL EMPLOYEE 
                                        STATEMENT 
 
   CHECK IF CHANGED 
 
Name _________________________________________________________________________________ 
Address _________________________________________________________________________________ 
City _________________________________ State __________ Zip ______________ 
Federal ID _________________________________ Phone _____________________ Ext _________________ 
 
                                                                             ACCOUNT NUMBER     YEAR 
 NOTE:  NO REFUNDS OR CREDIT WILL RESULT FROM ENTRIES MADE ON THIS 
 FORM.  A REFUND REQUEST MUST BE SUBMITTED TO THE FINANCE OFFICE. 
                            
QUARTER ENDING                          AMOUNT THAT SHOULD
                                              HAVE BEEN PAID     
1. MARCH 31ST                                            
2. JUNE 30TH                                            
3. SEPTEMBER 30TH                                       
4. DECEMBER 31ST                                        
5. TOTAL QUARTERLY TAXES THAT SHOULD HAVE BEEN PAID (Sum of Lines 1 - 4)                        
6. TOTAL TAXES WITHHELD PER SCHEDULE OF EMPLOYEES' WAGES ATTACHED                               
7. DIFFERENCE BETWEEN LINE 5 & LINE 6                                                           
 
___________________________________________________   ______________________________ 
AUTHORIZED SIGNATURE                                  DATE
 
INSTRUCTIONS FOR ANNUAL RECONCILIATION OF WITHHOLDING TAXES 
 
Employee’s federal W2s or employer’s federal W3 forms should be attached to 
this reconciliation.  Wage and Tax Statements should be submitted for only those 
employees that earned wages while working in the city limits of Paducah, Kentucky.  If 
additional tax is owed (Line 7), a check for the additional payment must be 
attached. Do not include the payment with your 4th quarter return. 
                                                                             th
This reconciliation form must be filed with the The City of Paducah, 300 S. 5  Street, 
Paducah, Kentucky 42002.   
 
MAILING ADDRESS: P.O. BOX 2697 •PADUCAH, KENTUCKY 42002-2697 
TELEPHONE: (270) 444-8513 •www.ci.paducah.ky.us FAX: •     (270) 444-8589