WOODFORD COUNTY FISCAL COURT
                                     NET PROFITS LICENSE FEE RETURN
Name and Address of Business                                                                                                     ACCOUNT NO.                                 CALENDAR/FISCAL YEAR ENDED

                                                                                                                                c
                                                                                                                                    OFFICE HOURS:                          I MONTH     I    OAY      I YEAR
                                                                                                                                                                 8:00-5:00                DUE DATE
                                                                                                                                                     MON - FRI
                                                                                                                                                                           I           I             [
                                                                                                                                                                           Attach a copy of FederalTaxReturn used
   INDICATE ANY NAME OR ADDRESS CHANGE ABOVE                                                                                     (859) 873-5701                            as basis of License Fee
QUESTIONS    (ANSWER         IN FULL)
1. Natureof Business-
                                                                                                               4. Did you have employees in Woodford County'!                                   DYes   D No
2. DateBusinessStartedinWoodfordCounty                                                                         5. Basis upon which tax return is prepared                                   D Cash     D Accrual
3. If Businesswas Discontinued,StateWhen                                                                       6. Business Type: DC-Corp D S-CorpD PartnershipD Sole-Prop.
DissolutionD or Sale D If by sale, give Name and Address of successor                                                                                              D Fiduciary D Other(Specify)
                                                                                                               7. Has the IRS changed the Net Income as originally reported for any
                                                                                                               prioryear?                                        D No D Yes(AttachScheduleof Changesfor eachyear)

                                                                 SCHEDULE                                                           A

   ANNUAL PAYROLL                             1. NET Business income per Federal Tax Return
   PAYROLL                                    2. ADD Items not Deductible (Line F, Schedule B Below)
                                              3. TOTAL (Line1 Plus Line 2)
                                              4. DEDUCT Items not subject (Line L, Schedule B)
RATE                 X 1.50%                  5. ADJUSTED NET BUSINESS 1NCOME (Line 3 less Line 4)
                                              6. If Sch. C (line4) is used enter here AVERAGE PERCENTAGE
                                              7. NET PROFITS subject to License Fee (Line 5 x Line 6)
AMOUNT DUE                                    8. Prior year adjustments
                                              9.ADJUSTEDNETPROFITS(Line7 lessLine8) If lessthan"0"enter "NONE
                                              10. License Fee - 1.5000%                                              of line 9
                                              11. Interest - 6.00 %                                        per annum
   Make checks payable and mail to:
                                              12. Penalty - 10.00 %
WOODFORD     COUNTY FISCAL COURT
                                              13. Total (Lines 10+11+12)
   103 SOUTH MAIN ST ROOM 201                 14. Less Credits - () ESTIMATE () OTHER
     VERSAILLES KY 40383
   Phone Number      (859) 873-5701           15. BALANCE DUE (Line 13 less Line 14 plus Farmer's Payroll)
                                              16. If estimate overpaid Indicate () Refund or () Credit
                                                                 SCHEDULE                                                        B
          NOTE: ADD AND OR DEDUCT       ONLY THOSE ITEMS WHICH ARE INCLUDED                                          IN CALCULATING                              1 INCOME PER FEDERAL RETURN
             ITEMSNOTDEDUCTIBLE-              ADD                                                                                                                  ITEMS NOT SUBJECT  -DEDUCT
A. State or Local taxes based on income                                                                                                   G. Alcohol Beverage Sales Deduction
B. Gain or loss on sales of business property                                                                                             H. Subtractions from Sched K and Rental Sched
C:Net operating Loss Deduction                                                                                                            I. Local Adjustments
D. Additions from Schedule K                                                                                                              J.
E.                                                                                                                                        K.
F. TOTAL ADDITIONS (enter on line 4)              n. ._-~._-----                                                                          L. TOTAL DEDUCTIONS (enter on line 4)                   n- .   .-
                                                         .       SCHEDULE C

                     ALLOCA TON FACTORS                                                                                                                                    Woodford       Total        Percent
1. Total Gross Business Receipts
2. Total Wages, Salaries and Other Personal Service
3.TOTALPERCENTS................""""""""""'...........................................................................................................".............                                               '
4.AVERAGEPERCENTAGE(Line3dividedby numberof percents)................................................................Enteron line6                                                                                i
   I hereby certify that the information, schedules, statements and exhibits filed herewith are true and correct.
   Signed                                                                                                                  Title                                                      Date
   THISRETURNIS DUEONOR BEFOREAPRIL 15, FORTHECALENDARYEAR ORWITHIN105DAYSOFTHEENDOFYOURFISCALYEAR
                                                                                                                                                                                                WCNP Rev.1211/2005
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