UNION COUNTY TAX ADMINISTRATOR 
                                                        NET PROFIT LICENSE FEE RETURN
***This form must be completed in its entirety.  If Federal I.D. or Social Security Number is omitted, this form will be returned to you.   If address change 
       applies, you must check the address change box.***                   
     CHECK IF ADDRESS CHANGE                     AMENDED RETURN                    NO ACTIVITY                  FEDERAL I.D. OR SOCIAL SECURITY NUMBER

Name:
Contact:                                                                                                                           FOR YEAR ENDING
Address:
City:                                State:  AL                             Zip:                                                   ACCOUNT NUMBER

Phone Number                                                Fax Number
     CHECK IF "FINAL RETURN"         Date Operations ceased                              ( Required to close account.)
                                                       *ALL LICENCEES MUST ANSWER THE QUESTIONS BELOW*
A. Principal business activity:
B. During the past year did Federal Authorities change or propose to change net income reported for that year or any prior year?
If YES, which year(s) was adjusted?                                               ( Attach statement of changes)
C. Principle owner/administrative officer:
Address:
D. Did you file a consolidated return?                 ( If yes, see instructions)
E. Was business activity discontinued?                 When?                                              For Dissolution            Sale/Transfer
    If sale / transfer state sucessor
    Address:
                      Did you make payments in the sum of $600.00 or mor to any individual for services rendered in this County other than an employee?   If YES, you 
     YES           NO are required to file copies of Federal Form 1099. 
                       
                                       *ALL LICENCEES MUST COMPLET PAGE 2 OF THIS FROM BEFORE COMPLETING THIS SECTION*
21. Enter ADJUSTED NET PROFIT ( From line 16 on the back of this form):

22. Enter percentage from Line 19 or 20
23 Net Profits Allocation (Line 21 x Line 22)
24 Union County License Fee (Line 23 x  0.5 %)
25. Credits: Estimated Payments

26. Balance of License Fees Due (Line 24 minus Line 25)
 27. There is a net profit maximum of $1000.00.  Pay the smaller amount of line 26 or 27                                           1000.00
28. Penalty - 5% per month, not to exceed 25% - Minimum $25; Penalty due on amount owed from original due date, unless full 
        estimated payments were made.  If payment not made by extension date, penalty will be calculated back to original due date.
29. Interest - 12  % per annum; Calculate interest on amount owed on Line 26 or 27 from original due date
30. Total amount due
31. Overpayment       Credit                Refund
Questions concerning this tax form contact the Union County Tax Administrator 270-389-3438
I hereby certify, under penalty of perjury, that the statements made herein and any supporting schedules are true, correct, and complete to the best of my knowledge.

Preparer Signature (Return must be signed)                                        Date    Taxpayer Signature (Return must be signed)              Date
Print Name                                                  Federal I.D.                  Print Name
Address                                                     Phone No.                     Title                                           SSN

                                                        Make check payable to: Union County Tax Administrator 
                      Mail this form along with supporting schedules to: Union County Tax Administrator * P.O. Box 60* Morganfield, KY 42437-0060 
      Return must be filed and paid in full by the fifteenth day of the fourth month after the close of the fiscal/calendar year, unless a filing extension has been granted. 

       COMPLETE THE APPLICABLE COLUMN AND ATTACH CORRESPONDING FEDERAL SCHEDULES EVEN IF A LOSS WAS INCURRED.

                                                                                                   INDIVIDUAL              PARTNERSHIP CORPORATION

1. Non-employee compensation reported as "other income" on Federal 1040  
    (Attach Page 1of For 1040 and Form 1099 if applicable)
2. Net profit per each Federal Schedule C, E, F and/or 4835 (If reporting more than  
    one schedule, losses incurred on any schedule cannot be netted against the  
    other schedules using seperate identification number)
3. Capital gain from Federal Form 4797 or Federal Form 6252 reported on  
    Schedule D of Form 1040 (Attach Form 4797, Pages 1 and 2 or Form 6252)
4. Ordinary gain or (loss) on the sale of property used a trade or business per  
    Federal Form 4797 (Attach Form 4797, pages 1 and 2)
5. Ordinary income or (loss) per Federal Form 1065 (Attach Form 1065, Pages 1,  
    2, and 3, Schedule(s) if applicable)

6. Taxable income or (loss) per Federal Form 1120 or 1120A or Ordinary income  
    or (loss) per Federal For 1120S (Attach Form 1120 or 1120A, Pages 1 and 2 or  
    1120 S, Pages 1, 2, and 3, Schedule of other Deductions, and Rental  
    Schedule(s) if applicable)
7. State income taxes and occupational license taxes based upon income   
    deducted on the Federal Schedule C, E, F, or Form 1065, 1120, 1120A or 1120S
8. Additions from Schedule K of Form 1065 or Form 1120S (Attach Schedule K 
    of Form 1065 or 1120S and Rental Schedule(s) if applicable)

9. Net operating loss deducted on Form 1120

10. Total Income - Add Line 1 through Line 9

11. Subtractions from Schedule K of Form 1065 or Form 1120S (Attach Schedule  
       K of Form 1065 or 1120S and Rental Schedule(s) if applicable)

12. Other Sales Deduction

13. Other Adjustments (Attach Schedule) 

14. Professional expenses not reimbursed by the Partnership (Attach Schedule  
       of Expenses)

15. Total Deductions - Add Line 11 through Line 14

16. Adjusted net profit - Subtract Line 15 from Line 10.  Enter here and on Line 21  
      on the front page                                                           

                                                     WORKSHEET Y: BUSINESS APPORTIONMENT
                                                                                                                           DIVIDE (A / B = C) 
               APPROTIONMENT                               COLUMN A                                COLUMB B 
                                                                                                                           NOTE: All percentages in Column C  
                   FACTORS                               UNION COUNTY                              TOTAL EVERYWHERE
                                                                                                                           should be carried out five (5) decimal places
17. PAYROLL FACTOR,  
       Compensation paid during the year to  
      employees
18. SALES REVENUE FACTOR 
       Receipts from the sale, lease, or rental of  
       goods, services, or property

19. TOTAL PERCENTAGES

20. BUSINESS APPORTIONMENT - Enter here and on Line 22 of NET PROFIT LICENSE FEE RETURN 
       If you had both a payroll factor and a sales revenue factor, then divide line 19 by two (2) 
       If you had a payroll factor or sales revenue factor, but not both, then enter the percentage from line 19 on line 22