BUSINESS PRIVILEGE LICENSE/GROSS RECEIPTS LICENSE FEE RETURN 
                                 
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City of Radcliff                Fee Return & Payment Due Date: 15  day of the                                
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PO Box 519                      4  month following the close of the taxable year 
Radcliff, KY 40159-0519 
(270)351-4714 
 
Business Type (check one):   _____Individual  _____Partnership  _____Corporation 
 
*This return must be filed with a copy of your federal income tax return with 
supporting schedules as follows: Individual (Form 1040 Schedule C and/or E); 
Partnership (Form 1065 and Form 8825, if applicable); Corporation (Form 1120 or Form 
1120S or Form 1120A and Form 8825, if applicable)       
 
Calendar/Fiscal Year Ended: Mo._____________  Day______ Year_______ 
 
Business Name and Address:         ___________________________________ 
                                                       ___________________________________ 
                                                       ___________________________________ 
                                                       ___________________________________ 
 
Federal ID # or Social Security # _____________   Radcliff Account #____________ 
 
Category _____ Article # _____  Description _____________________________ 
 
If business activity was discontinued in the tax jurisdiction during the year, state when: 
________________________. If business was sold, provide name and address of 
successor:_____________________________________________________________ 
**Note: You must contact this office to finalize and close your account 
 
PART A: TAXABLE GROSS RECEIPTS COMPUTATION 
 1. Gross Receipts from Form 1040 Schedule C                 ________________                             
 2. Gross Receipts from Form 1040 Schedule E                 ________________  
 3. Gross Receipts from Form 1065                            ________________ 
 4. Gross Receipts from Form 1120, 1120S, 1120A              ________________ 
 5. Gross Receipts from Form 8825                            ________________ 
 6.  Total Gross Receipts: (Add Lines 1 through 5)           ________________ 
 7.   Gross Alcoholic Beverage Sales                         ________________ 
 8.   Returns, Allowances and Bad Debts                      ________________ 
 9.   Sales Tax                                              ________________ 
 10.  Total Deductions (Add Lines 7 through 9)               ________________ 
 11.  Adjusted Gross Receipts (Subtract Line 10 from Line 6) ________________ 
  
PART B: BUSINESS APPORTIONMENT COMPUTATION 
*All licensees whose business operations were not conducted entirely in this taxing 
jurisdiction must complete this part.  Otherwise, you may skip to PART C. 

Apportionment                 COLUMN A          COLUMN B                          COLUMN C 
Factors:                      Radcliff Jurisdiction  All Jurisdictions            A/B=C 
1. PAYROLL FACTOR             ________________   _____________                    __________% 
    Compensation paid to  
    employees 
2. SALES FACTOR               ________________   _____________                    __________% 
    Adjusted gross receipts from                                  (From Line 11)  
    sales, rents, or services 
3. Total Percentages (Add Lines 1 and 2)                                          __________% 
4. Business Apportionment                                                                              
*If the business had both a sales factor and a payroll factor,                    __________% 
 (both factors must be greater than 0% to divide), then divide the total 
 percentages by two. However, if the business had either a sales factor or 
 a payroll factor, but not both, then enter the single factor  percentage here. 
   
PART A CON’T: TAXABLE GROSS RECEIPTS COMPUTATION  
   12. Business Apportionment % (if paying less than 100%       ________________% 
       of gross receipts) (from PART B, Line 4) 
   13. TAXABLE GROSS RECEIPTS (Multiply Line 11 x               _________________     
       Line 12) (Enter Result Here and on PART C, Line 1) 
        
PART C: LICENSE FEE COMPUTATION 
      1. Taxable Gross Receipts (From PART A, Line 11 or 13)    _________________ 
   2. Business Category Rate                                    _________________ 
   3. TOTAL LICENSE FEE DUE (Line 1 x Business                  _________________ 
          Category Rate)       
   4. Minimum Fee Due of $25 (If Line 3 is Less Than $25,       _________________   
          You Must Pay a Minimum Fee of $25) 
   5. Discount of 5% of License Fee (If Fee from Line 3 is      _________________  
       More Than $100 and Paid in Full 105 Days from the         
          Close of the Taxable Year, then Line 3 x 5%)  
   6. ADJUSTED LICENSE FEE DUE (After Discount)                 _________________ 
    
   *Deferred License Fee Option for Balances Over $100      
     (If Fee from Line 3 is More Than $100, Not Including  
     the $25 Minimum Fee, then Remaining License Fee May   
     be Split into Two Equal Payments) No Discount Taken  
   7. First Deferred Payment (Due 105 Days from the Close       _________________ 
       of the Taxable Year) (Line 3 Minus $25 / 2 Plus $25) 
   8.   Second Deferred Payment (Due 180 Days from the          _________________    
         First Deferred Payment Date) (Line 3 Minus Line 7)    
   9.   PENALTY @ 5% per Month from Due Date with $25           _________________    
       Minimum (Not to Exceed 25% of Total License Fee)                                                 
   10. INTEREST @ 1% per Month from Due Date                    _________________  
   11. TOTAL AMOUNT DUE Including Penalty & Interest            _________________     

*Please note: If a federal tax extension is filed with the IRS, a copy of the extension must 
be provided to the City of Radcliff and anestimated license fee must be paid (105 days    
from the Close of the Taxable Year).  Any adjustments will be made upon receipt of 
the actual return.  In addition, interest will be paid at a rate of 1% per month on the 
estimated fee from the time the fee was due until the actual return is filed and any 
additional fees paid.        
 
Return must be signed. I hereby certify, under penalty of perjury/ that the statements 
made herein and in any supporting schedules are true, correct, and complete to the best of 
my knowledge. 
 
___________________________________      _________________________________       
Preparer’s Signature              Date        Licensee’s Signature                  Date 
 
___________________________________      _________________________________ 
Printed Name                       Phone #      Printed Name                   Phone # 
         
Make check payable and mail to:           Forms are available on the internet at:   
City of Radcliff                          www.radcliff.org 
Finance Office 
PO Box 519 
Radcliff, KY 40159-0519