Transcription of WHITLEY COUNTY OCCUPATIONAL TAX OFFICE
1 WHITLEY COUNTY OCCUPATIONAL TAX OFFICED avid Owens, Tax Box 268 Williamsburg, KY 40769 Phone: 606 539-0477 Fax: 606 539-0478 Revised 9/30/2016 THIS FORM IS REQUIRED TO BE IN COMPLIANCE WITH WHITLEY COUNTY , KENTUCKY ORDINANCE NO. 2005-08**ANSWER ALL APPLICABLE QUESTIONS**THERE IS NO FEE FOR THE APPLICATION FOR BUSINESS LICENSE**NAME OF APPLICANT _____ BUSINESS NAME(If Different)_____ MAILING ADDRESS _____DATE OPERATIONS BEGAN _____IN WHITLEY COUNTY ____/___/_____ TELEPHONE NUMBER __(____)_____FAX NUMBER __(____)_____NATURE OF BUSINESS_____ ( Manufacturing, Postal, Restaurant, Type of Service, Type of Store, Real Estate, etc.) PHYSICAL LOCATION ____ COUNTY ____ CITY OF CORBIN ____ CITY OF WILLIAMSBURGFEDERAL TAX ID # ORCLOSING MONTH OF SOCIAL SECURITY # _____ACCOUNTING YEAR _____/___/_____TYPE OF BUSINESS __ C CORPORATION, __ S COPPORATION, __PARTNERSHIP, __ INDIVIDUAL, __FIDUCIARY/TRUST, __ OTHER _____DESCRIPTION DO YOU HAVEDO YOU HAVEEMPLOYEES _____ YES _____ NOSUBCONTRACTORS ____ YES ____ NO(IF YES YOU MUST SUBMIT COPIES OF FORM W-2) (IF YES YOU MUST SUBMIT COPIES OF FORM 1099)**COMPLETE THE FOLLOWING SECTIONS IF INFORMATION IS DIFFERENT FROM ABOVE**WITHHOLDING INFORMATION**CONTACT PERSON(S) _____MAILING ADDRESS_____CITY, STATE, ZIP _____TELEPHONE NUMBER __(____)_____FAX NUMBER __(____)
2 _____**NET PROFIT INFORMATION**BUSINESS NAME _____FEDERAL TAX # _____CONTACT PERSON(S) _____MAILING ADDRESS _____CITY, STATE, ZIP_____TELEPHONE NUMBER __(____)_____FAX NUMBER __(____)_____UNDER PENALTIES OF PERJURY, I DECLARE I HAVE EXAMINED THIS APPLICATION AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND TITLE_____ DATE _____OFFICIAL USE ONLY: ACCOUNT # _____
