MailFormFormDF-3 to:                       10/09
                                CITY OF WINCHESTER, KENTUCKY                                     Finance Department
                              RECONCILIATION OF LICENSE FEE WITHHELD                             City of Winchester
                                          During Year Ended __________                           P O Box 4135
                                                                                                 Winchester, KY 40392
    1793 Business Name ________________________________
                Address______________________________________
                City, ST, Zip__________________________________

                              th
To be filed by February 28 ,             or with Final Return upon completion of work or closing of a business.

How to Reconcile Your Payroll and Withholdings
Section 1 (Quarterly) or Section 2 (Monthly) -Under TOTAL PAYROLL enter the quarterly or monthly totals of all compensation 
paid all employees. Deduct any payments for services performed outside Winchester and enter balance in SUBJECT PAYROLL 
column. SUBJECT PAYROLL includes all compensation, i.e. Vacation and Holiday pay, tips and gratuities.
Attach a list of each subject employee, the Social Security Number, Name, Address, and Zip Code; total compensation paid and 
amount of Winchester license fee withheld Or submit copies of W2 forms with an adding machine tape total of the license fee 
withheld, or a computer generated report which provides the required information may also be submitted. Attach Form DF-3 with 
Section 1 or Section 2 completed to the top of any W2’s or computer listings.

SECTION 1 (Quarterly)         TOTAL PAYROLL SUBJECT PAYROLL                                      LICENSE FEE WITHHELD
1.  1 STQuarter ended March 31$__________________         $____________________  X       2.0%$__________________________
2.  2 ndQuarter ended June 30 $__________________         $____________________  X       2.0%$__________________________
3.  3 rdQuarter ended Sept 30 $__________________         $____________________  X       2.0%$__________________________
4.  4 thQuarter ended Dec 31  $__________________         $____________________  X       2.0%$__________________________
5.  TOTAL ALL QUARTERS        $__________________         $____________________                  $__________________________
6.  Actual Withholdings Remitted for the year on Form DF                                         $__________________________
7.  Difference between lines 5 and 6 (if any, check applicable block below)                      $__________________________
     ____Minor difference attributable to fractional variations only (no adjustments due)
     ____Difference indicates insufficient total remittance for year. Check for payment attached.
     ____Difference indicates overpayment not attributable to fractional variations. FULL EXPLANATION AND CLAIM FOR  
     REFUND IS ATTACHED.

8.  Number of Employees_________    ____________________________________  _________________________  ____________                           
                                                                                            Signature                                               Title                                   Date

SECTION 2 (Monthly)           TOTAL PAYROLL SUBJECT PAYROLL                                      LICENSE FEE WITHHELD
1.  January                   $__________________         $____________________  X 2.0% $__________________________
2.  February                  $__________________         $____________________  X 2.0% $__________________________
3.  March                     $__________________         $____________________  X 2.0% $__________________________
4.  April                     $__________________         $____________________  X 2.0% $__________________________
5.  May                       $__________________         $____________________  X 2.0% $__________________________
6.  June                      $__________________         $____________________  X 2.0% $__________________________
7.  July                      $__________________         $____________________  X 2.0% $__________________________
8.  August                    $__________________         $____________________  X 2.0% $__________________________
9.  September                 $__________________         $____________________  X 2.0% $__________________________
10.October                    $__________________         $____________________  X 2.0% $__________________________
11.November                   $__________________         $____________________  X 2.0% $__________________________
12.December                   $__________________         $____________________  X 2.0% $__________________________
13.  TOTAL ALL MONTHS         $__________________         $____________________                  $__________________________
14.  Actual Withholdings Remitted for the year on Form DF                                        $__________________________
15.  Difference between lines 5 and 6 (if any, check applicable block below)                     $__________________________
     ____Minor difference attributable to fractional variations only (no adjustments due)
     ____Difference indicates insufficient total remittance for year. Check for payment attached.
     ____Difference indicates overpayment not attributable to fractional variations. FULL EXPLANATION AND CLAIM FOR  
     REFUND IS ATTACHED.

16.  Number of Employees_________    ____________________________________  _________________________  ____________                           
                                                                                            Signature                                               Title                                   Date