To be completed in order to establish an account for reporting
OCCUPATIONAL LICENSE FEES
FOR
SCOTTSVILLE, KENTUCKY

Every business or individual subject to the Occupational License Fee is required to complete this questionnaire and return it to the City Treasurer along with a payment of $30.00
to obtain an Occupational License.

BUSINESS NAME____________________________________________________________________________

OWNER NAME(S)____________________________________________________________________________

___Individual ___Partnership ___Corporation (Date organized _____/_____/_____State_______)

ADDRESSES
Location Address: ____________________ B. Mailing Address: ____________________
____________________ ____________________
____________________ Website: ____________________
Location Phone: ____________________ E-Mail Address: ____________________
Location Fax: ____________________ Driver’s Lic. # ____________________

Local Manager/Rep Name: _______________________________ Phone: ____________________

NATURE OF BUSINESS (Please describe your business and its operation, including where and how sales, services, or other activities take place. Include site where working if here on particular contract):_______________________________________________________________________________

OPERATION IN SCOTTSVILLE STARTED _____/_____/_____
Mo Day Yr

DO YOU HAVE OR WILL HAVE EMPLOYEES WORKING IN SCOTTSVILLE?_____YES_____NO
A. Number of Employees_____ B. Estimated Quarterly Payroll $__________

ACCOUNTING PERIOD
_____Calendar Year - Dec. 31, or _____Fiscal Year Ended _____/_____
Mo. Day
BUSINESS FEDERAL IDENTIFICATION NUMBER_________________________________
BUSINESS OWNER(S) SOCIAL SECURITY NUMBER(S)_____________________________

IF BUSINESS WAS OBTAINED FROM A PREVIOUS OWNER:
A. Give Date of Acquisition______________B. Give Name of Previous Owner:___________________________

I HEREBY CERTIFY THAT ALL INFORMATION AND STATEMENTS HEREIN ARE TRUE AND CORRECT.

DATE:________________SIGNATURE:_____________________________________________________

FOR OFFICE USE ONLY

Acct #:_______

City of Scottsville, KY
Business License Registration Application
City Treasurer’s Office
201 West Main Street, Suite 8
Scottsville, KY 42164
(270) 237-4472 phone
(270) 237-4922 fax

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