"Net Profits License"
FORM 501 CITY OF FLEMINGSBURG 140 W. Electric Ave. NET PROFITS P.O. Box 406 LICENSE FEE RETURN Flemingsburg, KY 41041 Phone: (606) 845-5951 Business Name: Fax: (606) 845-0712 Street Address: Calendar Year ________________ City, State, Zip: or Fiscal Year ended ________________ Federal I.D. 1. If organization has been sold, discontinued or transferred, state when If sold or transferred, please list name, address & phone number of successor 2. If you derive receipts or have employees who work outside of Flemingsburg, please complete Schedule B- Local Allocation. 3. Have Federal authorities changed the Net Income as originally reported for a prior year? yes no 4. Check: Corporation _____ Partnership _____ Other (state) ___________________________________________________ PLEASE ATTACH APPROPRIATE IRS SCHEDULE PART A 1. Net Income $ 2. Add Items Subject: A. State & Local Taxes Based on Income $ B. Net Operating Loss Deduction $ C. Guaranteed Payments to Partners $ D. Other Items (List) $ 3. Total Items Subject $ 4. Add Lines 1 and 3 $ 5. Less Items Not Subject A. Interest Received* $ B. Dividends Received* $ C. Royalties on Patents, Copyrights $ D. Other Items (List) $ 6. Total Items Not Subject $ 7. Subtract Line 6 from Line 4, Adjusted Net Income $ 8. Local Taxable Percentage (see Schedule B, Line 7B below) $ 9. Net Profits subject to Flemingsburg License Fee, multiply Line 7 by Line 8 $ 10. Flemingsburg License Fee, ( Line 9 X 1%) $ 11. Interest, (1% of License Fees past due per month until paid) $ 12. Penalty, (10% of License Fees past due) $ 13. Total, Lines 10, 11 and 12 $ 14. Less Minimum Payment Paid (Business License fee for year being reported) $ 15. Less Estimated Payment Paid $ 16. Balance due (Line 13 Minus Line 14) $ *Exclusive if the Principal Business Activity is not Investments PART B - LOCAL ALLOCATIONS 1. Gross Receipts or Sales, Less Returns and Allowances $ 2. Gross Receipts or Sales, Flemingsburg Only $ 3. Local Business Receipts Percentage, Divide Line 2 by Line 1 $ 4. Total Salaries, Wages $ 5. Total Flemingsburg Salaries, Wages $ 6. Local Salary and Wage Percentage, Divide Line 5 by Line 4 $ 7. Add Lines 3 and 6 $ 8. Divide Line 7 by Number of Percents = Local Percentage $ I hereby certify that the statements herein and in any copies of supporting documents are true, correct and complete subject to any and all applicable fines and penalties. Make check payable to City of Flemingsburg. Signature of Preparer Date Returns must be postmarked by April 15th or no later than 3 months and 15 days after the end Signature of Taxpayer Date of your fiscal year unless an extension has been approved.