Reconciliation of Versailles License Fee Withheld
FORM 2
                                                 During Year Ended 20____
      TYPE OR PRINT IN THIS SPACE EMPLOYER'S NAME
                                                 1. TOTAL NUMBER EMPLOYEES AS LISTED HEREON ____________
      AND ADDRESS OF PRINCIPAL PLACE OF BUSINESS.

                                                 2. TOTAL VERSAILLES LICENSE FEE WITHHELD

                                                 QUARTER ENDED MAR. 31,
                                                 QUARTER ENDED JUNE 30,
                                                 QUARTER ENDED SEPT. 30,
                                                 QUARTER ENDED DEC. 31,
                                                                TOTAL REMITTED FOR YEAR
                                                 DUE FEBRUARY 28
SOCIAL SECURITY                                                                          OCCUPATIONAL LICENSE 
                NAME OF EMPLOYEE                                GROSS WAGES PAID
      NUMBER                                                                                   WITHHELD

IF REPORT IS COMPLETED ON THIS PAGE TOTAL HERE ……….     $                                     $
                                                 MAIL TO CITY OF VERSAILLES, KENTUCKY