Boone County Fiscal Court
                                                            www.BooneCountyKy.org
                                                                  2950 Washington Street
                                                              PO Box 960
                                                                 Burlington, KY 41005
                                                               (859) 334-2144
                                                                  (859) 334-3914 fax
                            Quarterly Withholding Tax Return for 201 8                        - TIF District
          **This form is only to be used by companies in the Park South at Richwood Development and The Friendly Market**
Name:                                                                     Account #: ________________________________________ 

dba:                                                                      FEIN/SSN:_________________________________________ 
                                                                          **Quarterly wage detail required**
Address:                                                                  For Quarter Ending: - (Circle Correct Date)
                                                                          03/31/1 8 due 0430/ /18           09/30/1 8due 1031//18 
City, State, Zip:                                                         06/30/1 8due  0731/ /18           12/31/1 8due 0131//19

Total Gross Earnings of All Employees Working in Boone County             $

Boone County Board of Education Tax - 1/2 of 1% (.005)
                        *****No Maximum*****
1) Gross earnings subject to Boone County Board of Education tax          $
2) Multiply Line 1 by 1/2 of 1% (.005)                                    $
3) Total Board of Education Tax                                                                             $
4) Late fee penalty 5% per month, maximum not to exced 25%,MINIMUM $25                                      $

Boone County Ordinance #07-27- 8/10 of 1% (.008)
        *****Max $60,236.00/tax of $481.89 PER EMPLOYEE*****
5) Gross earnings subject to Boone County payroll tax                      $
6) Multiply Line 5 by 8/10 of 1% (.008)                                    $
7) Less any KY Job Assessment Program credit                               $
8) Total Boone County Ordinance Tax                                                                         $
9) Late fee penalty 5% per month, maximum not to exced 25%,MINIMUM $25                                      $

Boone County TIF  - 2% 
      *****No Maximum*****SUBMIT WAGE DETAIL WITH RETURN******
10)Gross Earnings subject to TIF Tax                                       $
11) Tax due as calculated on wage detail                                   $
12) Total TIF Tax                                                                                           $
13) Late fee penalty 5% per month, maximum not to exced 25%,MINIMUM $25                                     $
Boone County Mental Health Tax Ordinance #07-26- 15/100 of 1% (.0015)
        *****Max $16,666.00/tax of $25.00  PER EMPLOYEE*****
14) Gross earnings subject to Mental Health Payroll tax                    $
15) Multiply Line 14 by 15/100 of 1% (.0015)                               $
16) Total Mental Health Tax                                                                                 $
17) Late fee penalty 5% per month, maximum not to exced 25%,MINIMUM $25                                     $

18) Interest fee  1% per month, 12% per year ((3+8+12+16)*%)                                                $
Total remittance (add lines 3,4,8,9,12,13,16,17,18)
Make check payable to:  Boone County Fiscal Court                                                           $
Statistical Information-REQUIRED
Total Number of Employees Working in Boone County

Signed:                                                                   Date:
Printed Name:                                                             Official Title:
Tax Form Prepared By:                                                     Telephone Number:
E-mail Address
I declare, under the penalties of perjury, that I have examined this document and to the best of my knowledge and belief, this is a true and accurate return.
Please notify in writing any changes of ownership or new address by completing a Request to Change/Close Occupational License Account which 
can be found on our website @ www.BooneCountyKY.org.  If you have any questions please call 859-334-2144 or email 
OccLicense@BooneCountyKY.org
Mail your return to:  Boone County Fiscal Court PO Box      457Florence , KY 41022-0457                                                                      Form 1907