PLEASE RETURN THIS FORM WITH PAYMENT                                                                                                                                                                   Form 541 
                                                                                                                 
  CITY OF STANFORD, KENTUCKY                                                                                           
  EMPLOYERS PAYROLL TAX RETURN                                                                                             
  STANFORD OCCUPATIONAL LICENSE FEE 
BUSINESS NAME &  ADDRESS HERE                                                                                     Return for Period Ended: 
                                                                                                                   
                                                                                                                  Number of Employees subject to 
                                                                                                                  Stanford License Fee: 
                                                                                                                   
All  organizations  are  required  to  submit  .65%  from  gross  wages  paid  employees  for  service 
within  the  City  of  Stanford.  Payment  and  this  return  are  due  on  the  last  day  of  the  month 
following the end of a quarter which is a period of three calendar months ended on March 31, 
June 30, September 30, or December 31.  
                                                         INSTRUCTIONS 
Line 1:  Enter total compensation paid during this quarter regardless of when or where earned. 
Line 2:  Enter the amount included in line 1 which represents payment for services performed or work done outside                    
             Stanford.  The employer must maintain adequate records to substantiate this amount. 
Line 5:  A penalty of 1% is imposed for each month or fraction thereof after the due date of the return during which   
             the license fee remains unpaid, to a maximum of 10%. 
Line 6:  Interest accrues on unpaid license fees as defined in KRS 131.010(6) from the due date of the return until      
             paid.  (The interest rate for  2000 is 9%). 
If  would like a copy of Stanford Occupational License Fee Ordinance or have any questions, please contact Sandy 
Gooch, City Clerk at (606) 365-4500.  
                                                         WORKSHEET 
1.  Total salaries, wages, commissions, and other compensation                                                       
2.  Amount included in line 1 paid for services outside Stanford                                                     
3.  Compensation subject to Stanford Payroll Tax (line 1 minus line 2)                                               
4.  Stanford Payroll Tax Due (.65% of line 3)                                                                        
5.  Penalty (see instructions)                                                                                       
6.  Interest (see instructions)                                                                                      
7. Total amount due (sum of lines 4, 5, and 6)                                                                       
I declare that to the best of my knowledge, and subject to City of Stanford Fines and Penalties, this is a true, correct, and complete return. 
 
Date:                                           Signature:                                                                       Title:                                                                
Make Check Payable To:  City of Stanford, 305 East Main Street, Stanford, KY 40484