EMPLOYER’S QUARTERLY RETURN OF LICENSE FEE WITHHELD 
 UNDER CITY OF PADUCAH, KENTUCKY ORDINANCE ADOPTED 5-31-50; AMENDED 1-31-08 

1.  NUMBER OF EMPLOYEES THAT RECEIVED EARNINGS IN PADUCAH DURING QUARTER.                                                
2.  TOTAL EARNINGS PAID ALL EMPLOYEES.                                                          IF NO WAGES WERE PAID 
                                                                     MARK “NONE”, SIGN AND RETURN                        
3.  EARNINGS FOR SERVICES RENDERED OUTSIDE PADUCAH.                                                                      
4.  TAXABLE EARNINGS (LINE 2 MINUS LINE 3).                                                                              
5.  ACTUAL FEE (LINE 4 MULITPLIED BY .02).                                                                               
6.  PENALTY (5% PER MONTH OF LINE 5 NOT TO EXCEED 25%) $25 MINIMUM.                                                      
7.  INTEREST (1% OF LINE 5 PER MONTH).                                                                                   
8.  TOTAL PAYMENT DUE.  PAYABLE TO:  CITY TREASURER                                             PO BOX 2697              
                                                                                                PADUCAH, KY 42002-2697 
 
I HEREBY CERTIFY THAT THE INFORMATION AND                                                       REPORT FOR THE QUARTER ENDING 
STATEMENTS CONTAINED HEREIN OR ATTACHED 
ARE CORRECT. 
 
SIGNATURE 
 
TITLE                                                          DATE 
 

                      INSTRUCTIONS FOR PREPARING AND FILING FORM W-1 
                                                             
Line 2-Enter total gross amount of all salaries, wages, commissions, bonuses, or other money payments of any kind, or any other  
            considerations having monetary value, which a person receives from, or is entitled to receive from or be given credit for    
            by his employer for any work done or personal services rendered by any employee.  Do not include any compensation 
            earned for services rendered prior to July 1, 1950.  If no compensation was paid during this quarter, so indicate and file 
            Form W-1 with explanation. 
 
Line 3-Enter that portion of compensation paid employees for services rendered outside the city of Paducah.  
 
Line 4-Enter the difference between Line 2 and Line 3. 
 
Line 5-Enter the amount of license fees withheld at the rate of 2 percent. 
 
Line 6-If the employer fails to remit the total amount of license fees withheld and file this return at the City Treasury by the last 
            day of the month following the end of the quarter for which this form is to be filed a 5% penalty, per month, must be  
            added to the figure shown in Line 5.  Not to exceed 25% with a $25.00 minimum. 
 
Line 7-If a penalty is required due to late payment interest at the rate of one percent of Line 5 per month must be added for 
            each month or fraction thereof of delinquency.  
 
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Line 8-Total of Lines 5, 6 and 7.                                                                                        
  
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   Revised 11/17/2016