WARREN COUNTY PUBLIC SCHOOLS 
                          OCCUPATIONAL LICENSE TAX APPLICATION (OLTA) 
         Phone: 270.842.7168                         Occupational Tax Department                                 Fax: 270.842.3411 
               303 Lovers Lane, PO Box 51530, Bowling Green, KY 42102 -- Website:             www.warrencountyschools.org                               
   NOTE: Please print legibly, type or visit www.warrencountyschools.org       and search for “OLTA” for the fillable PDF document. If you 
   complete the fillable PDF, please print, sign and mail to the address above. If you have any questions, please contact us via email (see               
   website) or via phone at 270.842.7168. Thank you for your time, compliance and assistance with this information.                                     
   1.    Applicant Information: 
         a.        Name of Applicant(s):                                                                                                            
         b.        Trade Name or DBA:                                                                                                               
         c.        Email:                                                      Website:                                                              
   2.    Identification Numbers:     Federal Employer ID #:                                           SSN:                                           
   3.    Warren County Location Information: 
         a.        How many locations will this business operate?           If more than one, attach a list, noting address of each location. 
         b.        Primary Warren County Physical Address(NO PO BOX):                                                                                
                                                                                                                                                     
         c.        Primary Warren County Contact Info:      Phone:                      Cell :                        Fax:                            
   4.    Property Information: Do you own the property in which you operate this business:              Yes      No –If no, attach copy of lease. 
   5.    Dates of importance within jurisdiction: Operations Began               /_     /        First Payroll           /_  /_                   
   6.    Description of Business Activity (check one): 
         Agriculture, Forestry, Fishing                            Mining                      Real Estate Sales           Wholesale Trade 
         Construction/Real Estate Development                      Public Administration       Retail Trade                Other                    
         Insurance                                                 Public Utilities            Services                
           Manufacturing                                           Rentals (RE)                Transportation                                        
   7.    Give brief description of primary business activity:                                                                                        
   8.    Accounting Period:     Calendar Year      or  Fiscal Year --If fiscal year, MM             /DD       to  MM         /DD                   
   9.    Payroll Withholdings: 
         a.        Will you have employees living in the Warren County Public School District and working within the County of 
                   Warren?      Yes  No -- If yes, approximate number?                  
         b.        Will you have contract (1099) labor in jurisdiction?     Yes     No 
         c.        First date wages and/or other compensations are to be paid to employees in jurisdiction?            /_    /_       
         d.        If you wish to have the withholding forms sent to an address other than listed in item “3(b)”, please see page 2. 
         NOTE:     Per Ordinance No. 46, adopted by the Board of Education and instituted January 1, 2008, §5 – Employers to Withhold – 
         It is the EMPLOYER’S responsibility to withhold the applicable tax and submit them on the required periodic basis utilizing the 
         required form(s). Employers who fail to comply shall be personally and individually liable to the District of which the District 
         shall have the right to levy a lien upon all the property of any employer who fails to comply with Ordinance No. 46. 
   10.   Business Situs: 
         NOTE:Business Situs constitutes business activity conducted within the jurisdiction that generates sales revenue or receipts                     
         from the sale, lease, or rental of goods, services or property within the jurisdiction and/or is paying compensation to employee(s) 
         working within the jurisdiction. 
         a.        Have you or will you be conducting business within the jurisdiction?        Yes    No 
         b.        Indicate the date business activity began or will begin within the jurisdiction:      /_       /_         
         c.        Is the business, within jurisdiction, to be:   Permanent      Temporary 
                            If temporary,approximate dates of activity: FROM             /     /_           TO         /_    /_        

         d.        Exempt?      Yes  No      If yes, please state the State Statute of Exemption:                                                       
   AFFIDAVIT: I hereby certify/declare under penalty of perjury under the laws of the state of Kentucky that all information 
   and statements herein and attached hereto are true and correct. 
 
   Applicant Printed Name:                                                                     Official Title:                                         
 
   Applicant Signature:                                                                        Date:                                                   
                                                                                                                                                         
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                                 WARREN COUNTY PUBLIC SCHOOLS 
                      OCCUPATIONAL LICENSE TAX APPLICATION (OLTA) 
      Phone: 270.842.7168                  Occupational Tax Department       Fax: 270.842.3411 

          303 Lovers Lane, PO Box 51530, Bowling Green, KY 42102 -- Website: www.warrencountyschools.org      
   THE INFORMATION PROVIDED BELOW IS CONFIDENTIAL & THEREBY NOT SUBJECT TO OPEN RECORDS 
 
   General Info.: 
      Primary Contact Name:                               Ph/Cell #:                                       
      Primary Contact’s Official Title:       Email:                                                       
      Secondary Contact Name:                             Ph/Cell #:                                        
      Secondary Contact Official Title:      Email:                                                        

      Primary Mailing Address:                              Phone No.:                                      
 
              Attention:                                     Cell No.:                                      
 
                                                            Fax No.:                                        
 
                                                            Email:                                          
 
              Website Address:                                                                               
 
   Home Office Info.:                                       
      Primary Mailing Address:                              Phone No.:                                      
 
              Attention:                                     Cell No.:                                      
 
                                                            Fax No.:                                        
 
                                                            Email:                                          
 
   To whom and where do you want the following mailed: 
 
   1. Quarterly Employee Withholding Returns: 
                                                            
      Primary Mailing Address:                              Phone No.:                                      
 
              Attention:                                     Cell No.:                                      
 
                                                            Fax No.:                                        
 
                                                            Email:                                          

   2. Net Profit License Returns:          
      Primary Mailing Address:                            _  Phone No.:                                     
 
              Attention:                                     Cell No.:                                      
 
                                                            Fax No.:                                        
 
                                                            Email:                                          
 
   Owner/Partner/Corporate Officer Info: 
       Attach Applicable KY Articles of Incorporation as Filed with the Secretary of State                
 
   W-9 REQUIRED:         Please attach a completed W-9 with your application. 

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