UNION COUNTY TAX ADMINISTRATOR
                                  P.O. BOX 60 MORGANFIELD KY 42437
                                                       (270) 389-3438
                 QUESTIONNAIRE FOR UNION COUNTY OCCUPATIONAL TAX ACCOUNT

Since every business must register and be assigned an account number, please complete the questionnaire below and
return it to this office. Non-profit organizations will not be required to file the Netprofit License Fee Return
provided  acopy of an Internal Revenue Service (IRS) letter of exemption  issubmitted  tosupport the non-profit
status.

1. Business  Trade or    Name

2. Local Business Address
      (No P.O. Boxes)

3. Forms Mailing Address
       (If different from #2

4. Business Telephone No. Fax E-Mail
       Ownership: Sole Proprietorship Partnership C Corp. S Corp Non Profit

5. Owners/Partners Names

       Corp. Officers & Titles

6. Owner Soc. Sec. Number - - Federal TIN -

7. Nature of Business

8. Date Business Started / /
       (In Union County)

9. Number of Employees
       Contract Labor (List names and address on back or separate sheet)

10. IRS Accounting period:
            Calendar Year Ends 12/31 Fiscal Year Ends /

11. List any other business entities  inUnion County

12. Business Location: Circle One

       Magistarial District  1 2 3 4 5 Out of County Out of State

13. Business Tax Type: Circle One Net Profit Only Payroll and Net profit