ANNUAL RECONCILIATION 

                                               RETURN OF OCCUPATIONAL TAX  

                                               City of Hillview, 283 Crestwood Lane, Louisville, Kentucky 40229 
                                                 Office: (502) 957-5280  Fax: (502) 955-5673 
                                                                                                           
Business Name:      _______________________________________________________________________ 

Address:            _______________________________________________________________________ 

City:               _______________________________________________________________________ 

State:              __________________________   Zip:  _____________________________ 

Account Number:     __________________________   Email: _____________________________ 

Due Date:           __________________________   Year:  _____________________________ 

Complete this form and return it with your fourth quarter return. Thanks in advance for your cooperation. 

                Quarter Ending                         Amount Paid 
                                                
1 stQuarter - March 31 st
                                                
2 ndQuarter - June 30 th
                                                
3 rdQuarter - September 30 th
                                                
4 thQuarter - December 31 st
                                                
Total Quarterly Taxes Paid 

Total Taxes Withheld Per Form W-2  

Difference Between Lines 5 & 6 

                                                  ANNUAL RECONCILIATION 

                                               RETURN OF OCCUPATIONAL TAX  

                                               City of Hillview, 283 Crestwood Lane, Louisville, Kentucky 40229 
                                                             Office: (502) 957-5280       Fax: (502) 955-5673 
                                                                                                           
1.    Must enter total number of employees                                                     
2.    Total salaries, wages, commissions and  other compensation paid                          
3.    Less compensation paid for services outside of the City of Hillview                      
4.    Taxable earnings (Item 2 minus Item 3)                                                   
5.    Actual tax due in Quarter at 1.8%                                                        
6.    Adjustments (Prior Quarters)                                                             
7.    Interest (1/2 of 1% per month)                                                           
8.    Penalty  (10%)                                                                           
9.    Total taxes due including penalty and interest                                           
  *If no wages were paid this quarter mark “None” and return this form with explanation 

If you employed less than 10 employees, use the space provided below OR furnish copies of each employee. 
Larger concerns may file their own listing (same format as below) or furnish W-2 copies. 
 
                                                                                         Occupational Tax 
Name of Employee       SSN                       Gross Wages  Taxable Wages              Withheld 
                                                                                          
      I hearby certify that all of the information and statements contained herein are true and accurate. 
 
____________________________________                 _________________________           __________________ 
Signature                                            Title                               Date