Phone No. (270) 842-7168    WARREN COUNTY SCHOOLS OCCUPATIONAL TAX                                                     Fax No. (270) 842-3411
                            303 Lovers Lane, Bowling Green, KY 42103
                            EMPLOYERS' ANNUAL RECONCILIATION OF                                                                                                                                                             
                                         LICENSE FEE/TAX WITHHELD

                                                        Social Security # 
Business #:    _________________________________        or Federal ID #:       ________________________

                                                                                                                       For Year Ended

                                 WITHHOLDING PAYMENT SCHEDULE

1st Qtr                          2nd Qtr                       3rd Qtr                                        4th Qtr
             Total Number of Employees:                                              Total Payments                  $ $0.00

                                                               FEE COMPUTATION
***IMPORTANT***
                            1.)         Total Wages, Tips, Other Compensation per Box 1 of Federal Form     
                                 W-2 or W-3
APPROPRIATE 
                            2.)Add: Deferred Compensation Contributed by Employees (i.e., 
SCHEDULES MUST       
                                 Retirement, Profit Sharing, Deferred Compensation Plans, Cafeteria 
BE ATTACHED
                                 Plans, etc.)
Enclose Copies of ALL 
Federal Forms W-2 and W-    3.) Add: Welfare Benefit, Fringe Benefit, or Other Benefit Plan Payments 
3, Transmittal of Wage and       Contributed by an Employee
Tax Statements, or a        4.) Total Gross Compensation (Add Lines 1 through Line 3)
Detailed Listing of ALL 
Employees with the          5.)Less: Total Gross Compensation Paid for Service Outside of Warren 
Required Equivalent              County, Kentucky and/or Gross Nonresident Compensation
        Information
                            6.) Taxable Compensation (Subtract Line 5 from Line 4)                                                                 $0.00

                            7.) Occupational License Fee (Line 6 X .005)
             DUE
FEBRUARY 28
                            8.) Total Payments Remitted                                                                                            $0.00
                            9.) Balance Due (If Line 7 Exceeds Line 8 = Line 7 Minus Line 8)           
        Remit To:                (No adjustment due for minor differences attributable to fractions of cents)
Warren County Schools 
Quarterly Tax Return        10.) Penalty @ 5% per month (Not to Exceed 25%; Minimum $25                      )
P.O. Box 890947
        Charlotte, NC       11.) Interest @ 1% per month from Due Date
        28289-0947

        Website:            12.) TOTAL AMOUNT DUE (Line 9 Plus Lines 10 and 11)                                                                    

www.warrencountyschools.org 13.) Overpayment Claimed (If Line 8 exceeds Line 7)
                                           Refund                Credit to Next Year Estimated Payment
RETURN MUST BE SIGNED - I hereby certify, under penalty of perjury, that the statements made herein and in any supporting schedules are true, correct, and complete to the best of 
my knowledge.

SIGNATURE                   TITLE                         DATE              PHONE #                           EMAIL ADDRESS