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CITY OF SCOTTSVILLE, KY - OCCUPATIONAL TAX 20
Make Check Payable And Mail To: CHECK CASH
City of Scottsville Net Profits Occupational Tax Return
201 W. Main, Suite 8
Scottsville, Ky 42164 FROM BUSINESS, PROFESSION, OR OTHER ACTIVITY WITHIN
SCOTTSVILLE, KY. CONDUCTED BY CORPORATIONS, PARTNERSHIPS,
Information Request INDIVIDUALS AND FIDUCIARIES OF ESTATES AND TRUSTS.
Ph: 270-237-4472 (RESIDENT OR NON RESIDENT)
Fx: 270-237-4922
CALENDAR YEAR ENDED DECEMBER 31, 20
OR
FISCAL YEAR INDICATED BELOW
This return must be filed with full payment of the fee on or before May 15 of each year, Return even if a net loss or copy of extension.
MO. DAY YR.

(PRINT NAME AND ADDRESS ABOVE - CHANGE IF NOT CORRECTLY SHOWN)

Give Trade Name, If Any
Nature of Business

SOCIAL SECURITY # OR
FEDERAL IDENTIFICATION #. No.
QUESTIONS (ANSWER FULLY) 3. Check Which: Corporation Sub-Chapter S Partnership
1. Did you have employees in Scottsville during year? Yes No Individual Owner Fiduciary Other (state)
2. Has Scottsville License fee been withheld from all subject Employees, 4. Basis on which this Return is Prepared-Cash Accrual
and Remitted Quarterly in Accordance with these Regulations? 5. Have Federal Authorities Changed the Net Income as Originally
Yes No If Answer is “No” Explain Reported for Any Prior Year? Yes No
If Answer is “Yes” Attach Schedule of Changes for Each Year.

SCHEDULE A
1. Net Business Income per Federal Return................................................................. $ (Do not write in this space)
2. ADD Items not deductible (Line G, Schedule B)...................................................
3. Total (Line 1 plus Line 2)...........................................................................................
4. DEDUCT items not subject (Line N, Schedule B).................................................
ADJUSTED NET BUSINESS INCOME (Line 3 less Line 4).............................. $
6. If Sch.C (Line 4) is used enter here AVERAGE
PERCENTAGE........................................................................................................... %
7. NET PROFITS Subject to Scottsville
License Fee (Line 5 x Line 6)..................................................................................... $
8. Scottsville License $
Fee at 1.5% of amount on Line 7..............................................................................
9. Minimum License Fee .......................................................................................... 30 00
10. Interest 1/2 of 1% per month if paid after due date................................................
11. Penalty - 1% per month not exceeding 10% if paid 30 days after due date.........
12. Total (Lines 8+9+10+11)......................................................................................... $
13. Less credits - ESTIMATED PMTS..........................................................................
14. Less credits - ADVANCE LICENSE FEE..............................................................
15. BALANCE DUE. . PAY THIS AMOUNT..............................................................
16. OVERPAYMENT REFUND CREDIT ................................................$

34240MS - UNITED SYSTEMS & SOFTWARE, INC. - BLACK INK

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SCHEDULE B
NOTE: ADD AND/OR DEDUCT ONLY THOSE ITEMS WHICH ARE INCLUDED IN CALCULATING NET INCOME
ITEMS NOT DEDUCTIBLE - ADD ITEMS NOT SUBJECT - DEDUCT
A. Federal or Local taxes based on income............ $ H. Interest on Corporate Bonds................................ $
B. License Fee under this Ordinance...................... I. Interest on U.S. Government Securities.............
C. Ordinary Gain....................................................... J. Royalties on Patents, Copyrights.........................
D. Net Operating Loss Deduction........................... K. Dividends...............................................................
E. Partners’ Salaries (attach schedule).................... L. Ordinary Loss........................................................
F. Other items (list)....................................................M. Other (attach schedule)........................................
G. TOTAL ADDITIONS (enter on Line 2)........... N. TOTAL DEDUCTIONS (& enter on Line 4).. $

SCHEDULE C
Business Allocation Percentage - Divide (Col. A) by (Col. B) to obtain decimal. Carry out at least 6 places.
ALLOCATION FACTORS Column A Column B Column C
Scottsville Total Everywhere PERCENTAGE (A+B)
$ $
1. Total Net Business Profits Per Federal Returns
2. Total Wages, Salaries and Other Personal Service
Compensation Paid to Employees.

3. TOTAL PERCENTS: Add Lines 1,2 .................................................................................................................................................... %
4. AVERAGE PERCENTAGE (Line 3 divided by 2)............................................................................Enter on Line 6...................... %

CERTIFICATE
Prepared By
I HEREBY CERTIFY That the statements made herein and any supporting schedule or exhibit are true, correct and complete.
(Signature of License Fee Payer) Date 20

34240MS - UNITED SYSTEMS & SOFTWARE, INC. - BACKER BLACK INK

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CITY OF SCOTTSVILLE, KY -OCCUPATIONAL TAX 20 Net Profits Occupational Tax Return FROM BUSINESS, PROFESSION, OR OTHER ACTIVITY WITHIN SCOTTSVILLE, KY. CONDUCTED BY CORPORATIONS, PARTNERSHIPS, INDIVIDUALS AND FIDUCIARIES OF ESTATES AND TRUSTS. (RESIDENT OR NON RESIDENT) CALENDAR YEAR ENDED DECEMBER 31, 20 OR FISCAL YEAR INDICATED BELOW Make Check Payable And Mail To: City of Scottsville 201 W. Main, Suite 8 Scottsville, Ky 42164 Information Request Ph: 270-237-4472 Fx: 270-237-4922 MO. DAY YR. CHECK CASH (PRINT NAME AND ADDRESS ABOVE -CHANGE IF NOT CORRECTLY SHOWN) Give Trade Name, If Any Nature of Business SOCIAL SECURITY # OR FEDERAL IDENTIFICATION #. No. QUESTIONS (ANSWER FULLY) 1. Did you have employees in Scottsville during year? Yes No 2. Has Scottsville License fee been withheld from all subject Employees, and Remitted Quarterly in Accordance with these Regulations? Yes No If Answer is “No” Explain 1. Net Business Income per Federal Return................................................................. 2. ADD Items not deductible (Line G, Schedule B)................................................... 3. Total (Line 1 plus Line 2)........................................................................................... 4. DEDUCT items not subject (Line N, Schedule B)................................................. ADJUSTED NET BUSINESS INCOME (Line 3 less Line 4).............................. 6. If Sch.C (Line 4) is used enter here AVERAGE PERCENTAGE........................................................................................................... 7. NET PROFITS Subject to Scottsville License Fee (Line 5 x Line 6)..................................................................................... 8. Scottsville License Fee at 1.5% of amount on Line 7.............................................................................. 9. Minimum License Fee .......................................................................................... 10. Interest 1/2 of 1% per month if paid after due date................................................ 11. Penalty -1% per month not exceeding 10% if paid 30 days after due date......... 12. Total (Lines 8+9+10+11)......................................................................................... 13. Less credits -ESTIMATED PMTS.......................................................................... 14. Less credits -ADVANCE LICENSE FEE.............................................................. 15. BALANCE DUE. . PAY THIS AMOUNT.............................................................. 16. OVERPAYMENT REFUND CREDIT ................................................ 3. Check Which: Corporation Sub-Chapter S Partnership Individual Owner Fiduciary Other (state) 4. Basis on which this Return is Prepared-Cash Accrual 5. Have Federal Authorities Changed the Net Income as Originally Reported for Any Prior Year? Yes No If Answer is “Yes” Attach Schedule of Changes for Each Year. % $ $$$ $$ (Do not write in this space) SCHEDULE A This return must be filed with full payment of the fee on or before May 15 of each year, Return even if a net loss or copy of extension. 30 00A. Federal or Local taxes based on income............ B. License Fee under this Ordinance...................... C. Ordinary Gain....................................................... D. Net Operating Loss Deduction........................... E. Partners’ Salaries (attach schedule).................... F. Other items (list).................................................... G. TOTAL ADDITIONS (enter on Line 2)........... 1. Total Net Business Profits Per Federal Returns 2. Total Wages, Salaries and Other Personal Service Compensation Paid to Employees. 3. TOTAL PERCENTS: Add Lines 1,2 ................................................................................................................................................... 4. AVERAGE PERCENTAGE (Line 3 divided by 2)............................................................................Enter on Line 6...................... %% $ SCHEDULE B NOTE: ADD AND/OR DEDUCT ONLY THOSE ITEMS WHICH ARE INCLUDED IN CALCULATING NET INCOME SCHEDULE C Business Allocation Percentage -Divide (Col. A) by (Col. B) to obtain decimal. Carry out at least 6 places. H. Interest on Corporate Bonds................................ $ I. Interest on U.S. Government Securities............. J. Royalties on Patents, Copyrights......................... K. Dividends............................................................... L. Ordinary Loss........................................................ M. Other (attach schedule)........................................ N. TOTAL DEDUCTIONS (& enter on Line 4).. $ $ $ ITEMS NOT DEDUCTIBLE -ADD ITEMS NOT SUBJECT -DEDUCT ALLOCATION FACTORS Column A Scottsville Column B Total Everywhere Column C PERCENTAGE (A+B) Prepared By I HEREBY CERTIFY That the statements made herein and any supporting schedule or exhibit are true, correct and complete. (Signature of License Fee Payer) CERTIFICATE Date 20

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