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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
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