Office of Occupational License Fee Administrator  
                                        401 Court Square · Suite 6 
                                        PO Box 177 
                                        Barbourville, KY  40906 
                           Phone: 606.546.8915 · Fax: 606.546.6196 
                                        kfctax@barbourville.com 

Every business or individual subject to the Occupational License Fee is required to complete this 
application and return it to the Fee Administrator.  Answer all applicable questions. 

FOR BUSINESS USE ONLY: 
Name of business or trade name:____________________________________________________________ 

Business Street Address:__________________________________________________________________ 
(Knox County Address) 

City, State, Zip__________________________________________________________________________ 

Telephone Number: (_____)_________________________Fax Number (_____)_____________________ 

______________________________________________________________________________________ 

Mailing Address:________________________________________________________________________ 
(To receive quarterly and annual forms) 

City, State, Zip__________________________________________________________________________ 

Telephone Number: (_____)_________________________ Fax Number (_____)_____________________ 

Date operations started in Knox County:________________ Approximate Number of Employees________ 

Nature of Business:______________________________________________________________________ 

Type of Business: ____Corporation ____S Corporation ____Partnership ____Individual ____Fiduciary 

                  ____Farm ____LLC ____Religious or Non-Profit Organization ____Proprietorship 

                  ____Other (Please specify) _________________________________________________ 

Federal Tax ID# __________________________________ 

Accounting period: ________ Calendar year (December 31) or ______ Fiscal year (month____________) 

List previous owner’s name and address: ____________________________________________________ 

List contact person(s) names(s): _______________________________ Telephone: (____)_____________ 

Form continues on reverse… 

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INDIVIDUAL USE ONLY: 
(also for those persons whose employer does not withhold quarterly taxes – including federal employees, 
i.e. United States Postal Service) 
 
Name: ___________________________________________ 
 
Address: _________________________________________ 
 
City, State Zip: ____________________________________ 
 
Federal Agency or Business for which you work and address:_____________________________________ 
 
______________________________________________________________________________________ 
 
Start date: ____________________________               Social Security No.: _________________________ 
 
Telephone (Agency): (____)_____________________________      (Home) (____)___________________ 
 
CONTRACTORS: 
List all Subcontractors working under you on this or any job in Knox County with address, social security 
information and phone number.  (Use additional sheet if necessary) 
 
______________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
PARTNERSHIPS: 
List All Partners with Address and Social Security Information.  (Use additional sheet if necessary) 
 
______________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
______________________________________________________________________________________ 
 
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS 
APPLICATION, AND AS TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS TRUE, 
CORRECT AND COMPLETE. 
 
Signature: ______________________________________ 
 
Title: __________________________________________ 
Date: __________________________________________ 
                                    
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