MCLEAN COUNTY TAX ADMINISTR

                                   MCLEAN COUNTY, KY
                NET PROFIT LICENSE TAX RETURN FOR YEAR:               2021
                                                    P.O. BOX 128
                                                                                                                 (270) 273-9170
                                                    CALHOUN KY 42327                                          www.mcleancounty.ky.gov
                                                                                                              jedmonds@mcleanky.com

                                                                       FISCAL YEAR ENDED                      12      / 31 / 2021
                                      ACCOUNT NUMBER                        DUE DATE                          04      / 15 / 2022
Name and Address of Business                        00002              DUE BY FEDERAL TAX DAY FILE DATE, UNLESS FILING AN EXTENSION
MICHAEL L BRAWNER, JR
                                                                 DID YOUR BUSINESS ACTIVITY CEASE IN MCLEAN COUNTY?

PO BOX 467                                                                  _____ YES                         _____ NO
CALHOUN KY 42327
                                                                 Cease Date:
INDICATE ANY NAME OR ADDRESS CHANGE ABOVE

                             COMPUTATION OF NET PROFIT LICENSE TAX

1. Total Gross Receipts/Income in McLean County
(Business Income, Farm Income, Rental Income, etc.)                    $   ___________________________________

2. Total Expenses in McLean County                                     $   ___________________________________

3. TOTAL (Line1 less Line 2)                                           $   ___________________________________

4. License Tax Due - 1% of line 3                                      $   ___________________________________
MAXIMUM DUE $750.00                MINIMUM DUE $50.00

5. INTEREST for Late Payment - 1% Per Month                            $   ___________________________________

6. PENALTY for Late Payment - 5% per month,
     $25.00 minimum, not to exceed 25%                                 $   ___________________________________

7. Employees Occupational License Tax 
                                                                       $   ___________________________________
(Applicable if not paid on a Quarterly Basis) - 1% of Gross Wages

8. Credit (Prior Payment - Must Attach Proof of Prior Payment)         $   ___________________________________

9. TOTAL AMOUNT DUE
Line 4 + Line 5 + Line 6 + Line 7 - Line 8 = Line 9                    $   ___________________________________
If a refund is due, please attach letter for request of refund. No refund or credit after 2 yrs of overpayment

     Please make checks payable and mail to:                     MCLEAN COUNTY LICENSE TAX ADMINISTRATOR
                                                                            P.O. BOX 128
                                                                       CALHOUN KY 42327
I hereby certify that the statements made herein and in any supporting documents are true, correct, and complete to the best of my knowledge.

_______________    _______________________________________________                      _____________________
Date                                                Taxpayer Signature                                        Title
Firm Name and Address:_________________________________________________________________________________

Date:_____________________         Signature of Preparer:_____________________________________________________
                                                                                                                        MCNP Rev. 9/16/2021