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

                                          Net Profit Extension Request for 2018

Name:                                                                                      Account #: ________________________________________ 

dba:                                                                                       FEIN/SSN:_________________________________________ 

Address:                                                                                   For the Year Ended: _______________________________
                                                                                                                            (required)
City, State, Zip:                                                                          Due Date*:_________________________________________ 
                                                                                           *Due date is the 15th day of the 4th month after the end of the fiscal year

1) Estimated Tax for Year Ended                                                                                                            $

2) Add Annual Business License ($25.00 per business)                                                                                       $
                (Additional fees for multiple physical locations)

3) Overpayment from Prior Year                                                             $
4) Prior Estimated Tax Payments                                                            $
5) Total Payments (add lines 3 & 4)                                                                                                        $ 0.00

Total remittance (add lines 1 plus 2 minus line 5)                                                                                         $ 0.00
Make check payable to:  Boone County Fiscal Court

Signed:                                                                                    Date:
Official Title:                                                                            Printed Name:
Tax Form Prepared By:                                                                      Telephone Number:
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

                                                                              Instructions

1. You must complete a Net Profit Extension Request(or the equivalent) to extend a Net Profit Return beyond its original due date (105 days
 from the end of the fiscal year).
2. Each business account must remit a minimum of $25.00 per location with an extension request for the Annual Business License Renewal.
 The business license is set to expire upon the original due date of the Net Profit Return.
3. Each account has a minimum of one (1) business location and/or performs a service in Boone County.
 In the case of multi-location entities within Boone County, each location must remit a $25.00 fee PER location.
4. Please insure that any overpayment claimed from a prior year return has not already been refunded by Boone County to the business.
5. Please attach a copy of this completed extension request to the actual Boone County, Kentucky, Net Profit Tax Return upon
 filing of the return.
6. Once approved your extension request is for 6 months from the original filing due date.
7. This extension form extends the filing of the return but does not extend the time for paying the tax due.
8. Any tax not paid by the original due date will be subject to interest fees.
                                               Mail your return to:  Boone County Fiscal Court
                                  (PO Box 457, Florence, KY 41022-0457)  isfor returns WITH PAYMENT and 
                                  (PO Box 960, Burlington, KY 41005-0960)   foris           returns WITHOUT PAYMENT.
                                                                                                                                                                      Form  0506