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                         MCLEAN COUNTY TAX ADMINISTRATOR
                         EMPLOYER'S QUARTERLY RETURN OF LICENSE TAX WITHHELD
                                   If no wages were paid this period, mark "NONE", sign and return this form
   1. Salaries, wages, commission & any compensation              DID YOUR BUSINESS ACTIVITY CEASE IN MCLEAN COUNTY?
      paid all employees for services in McLean County
                                                                                                                 YES _____     NO _____
   2. TAX DUE AT - 1.00%                                          I hereby certify that the information, schedules, statements and
                                                                  exhibits filed herewith are true and correct.
   3. LATE CHARGE PENALTY - 5% OR $25.00 MINIMUM
   4. LATE CHARGE INTEREST - 1% PER MONTH                         Signed   ________________________________________________
   5. BALANCE DUE                                                 Official Title   ___________________________   Date  ___________
                                                                  FOR PERIOD ENDING                              Make checks payable and
      JOSH CONSULTING SERVICES INC                    Account No. Month Day                                 Year mail to:
                                                                                                                 MCLEAN COUNTY TAX
      YOGI 11 INC   DBA MARATHON                      05007       09    30                                  2021 ADMINISTRATOR
      1051 PERIMETER DR STE 260                                   RETURN DUE ON OR BEFORE                        P.O. BOX 128
      SCHAUMBURG IL 60173                                         Month Day                                 Year CALHOUN KY 42327
                                                                  10    31                                  2021 Phone: (270) 273-9170
                                                                                                                 WWW.MCLEANCOUNTY.KY.GOV
      Indicate any name or address change above                                                                  Email: jedmonds@mcleanky.com
                                 *PLEASE MAKE A COPY OF THIS FORM FOR YOUR RECORDS.*