Phone No. (270) 842-7168             EXTENSION APPLICATION                                                   Fax No. (270) 842-3411 

WARREN COUNTY SCHOOLS ANNUAL OCCUPATIONAL NET PROFIT TAX RETURN 
                                     303 Lovers Lane, Bowling Green, KY 42103 

Please type complete name and address of           Date 
applicant in space below. 
                                                             **THIS FORM MUST BE FILED ON 
                                                             OR BEFORE THE ORIGINAL DUE 
                                                             DATE OF THE RETURN** 

FEIN #                                      SOCIAL SECURITY # 

A_____________ month extension is requested for filing the Net Profit Return of the above named taxpayer for  

the year ending _________________________________. 

REASON FOR REQUEST: 

_______________________________________________________________ 
_______________________________________________________________ 
_______________________________________________________________ 
_______________________________________________________________ 
_______________________________________________________________ 

Signature ___________________________________________ Title __________________________________ 

Print Name _____________________________________  Phone #:  __________________________________ 

Estimated Tax Due…………………………………….. $___________________________ 

NOTE:  This extension is granted subject to the provision that any balance outstanding when payment is due is subject to interest 
charges of (1%) one percent per month (12% per annum) of the unpaid balance until paid in full.  No penalty {equal to 5% per month 
(not to exceed 25%; Minimum $25.00)} shall be assessed in those cases in which all filing and payment requirements have in good faith 
been fulfilled and the final license tax and interest is paid with the filing of the Net Profit License Tax Return within the period as 
extended. The required estimated license tax payment is presumed to have been made in good faith provided that the taxpayer remits 
with the timely filed extension request 50% or more of the license tax liability as indicated on the extended Net Profit License Tax 
Return.  

Mail this completed form             WARREN COUNTY SCHOOLS NET PROFIT 
and extension payment                RETURN P. O. BOX 890944 
(if applicable) to:                  CHARLOTTE, NC 28289-0944