Boone County Fiscal Court
                                                              www.BooneCountyKy.org
                                                                     2950 Washington Street
                                                                    PO Box 960
                                                                     Burlington, KY 41005
                                                                     (859) 334-2144
                                                                           (859) 334-3914 Fax

                                         Amended Quarterly Withholding Tax Return for 2020
Name:                                                               Account #: ________________________________________ 

dba:                                                                FEIN/SSN:_________________________________________ 
                                                                                             (please advise if incorrect)
Address:                                                            For Quarter Ending: - (Circle Correct Date) 
                                                                    03/31/20 due 0 /4 30/20     09/30/20 due 11/02/20 
City, State, Zip:                                                   06/30/20 due 07/ 1/3     20 12/31/20 due 02/01/21
                                                                             Original                                         Amended
Total Gross Earnings of All Employees Working in Boone County       $                           $
Boone County Board of Education Tax - 1/2 of 1% (.005)
                      *****No Maximum*****                                   Original                                         Amended
1) Gross earnings subject to Boone County Board of Education tax    $                            $
2) Multiply Line 1 - by 1/2 of 1% (.005)                            $ 0.00                       $ 0.00
3) Interest Fee 1% per month, 12% per year                          $                           $
4)  Less credit for overpayment in prior quarter-attach explanation $                           $                                                            Difference
5) Total Board of Education Tax                                     $ 0.00                      $ 0.00                                                       0.00
Boone County Ordinance #07-27- 8/10 of 1% (.008)
      *****Max $63,136.00/tax of $505.09 PER EMPLOYEE*****                   Original                                         Amended
6) Gross earnings subject to Boone County payroll tax               $                           $
7) Multiply Line 6 - by 8/10 of 1% (.008)                           $ 0.00                      $ 0.00
8) Interest Fee  1% per month, 12% per year                         $                           $
9)  Less credit for overpayment in prior quarter-attach explanation $                           $
10) Less any KY Job Assessment Program credit                       $                           $                                                            Difference
11) Total Boone County Ordinance Tax                                $ 0.00                      $ 0.00                                                       0.00
Boone County Mental Health Tax Ordinance #07-26- 15/100 of 1% (.0015)
        *****Max $16,666.00/tax of $25.00  PER EMPLOYEE*****                 Original                                         Amended
12) Gross earnings subject to Mental Health Payroll tax             $                           $
13) Multiply Line 12 by 15/100 of 1% (.0015)                        $ 0.00                      $ 0.00
14) Interest Fee  1% per month, 12% per year                        $                           $
15) Less credit for overpayment in prior quarter-attach explanation $                           $                                                            Difference
16) Total Mental Health Tax                                          $ 0.00                      $ 0.00                                                      0.00
Total remittance (add lines 5,11,16)                                                                                          Payment                 Credit to MM/YY or Refund
Make check payable to: Boone County Fiscal Court
             If the amended return results in a overpayment you can request the amount to be a credited to another quarter or you can request a refund after year end processing.
Statistical Information-REQUIRED
Total Number of Employees Working in Boone County
Signed:                                                             Date:
Official Title:                                                     Telephone Number:
Tax Form Prepared By:

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
Make check payable to:  Boone County Fiscal Court
Mail your return to:
(PO Box 457, Florence, KY 41022-0457) are for returns WITH PAYMENT and 
(PO Box 960, Burlington, KY 41005-0960) are for returns WITHOUT PAYMENT                                                                                          Form 2306