CITY OF FLEMINGSBURG		140 West Electric Ave.
				NET PROFITS		P.O. Box 406
				LICENSE FEE RETURN		Flemingsburg, KY 41041
						Phone:  (606) 845-5951
						Fax:  (606) 845-0712
_______________________________						Calendar Year
Federal I.D.  __________________________						20______
DBA:  _________________________________________________						or Fiscal Year Ended
Street Address:  ________________________________________						_________
City, State, Zip:  ________________________________________
1.  If organization has been sold, discontinued or transferred, state when___________________________________________
If sold or transferred, please list name, address & phone 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 IRS SCHEDULE
				SCHEDULE A
1.  Net Income……………………………………………………………………………………………..$
2. Less items not subject
A. Interest Received*
B. Dividends Received*
C. Royalties on Patents, Copyrights
3.  Total Items not Subject………………………………………………………………………………………
4.  Subtract line 3 from line 1, Adjusted net income………………………………………………………………………………………..
5.  Local Taxable Percentage (see Schedule B, Line 3B below)……………………………………….
6.  Net Profits subject to Flemingsburg License Fee,
multiply Line 4 by Line 5………………………………………………………………………………
7 .  Flemingsburg License Fee, (Line 6 X 1%)………………………….
8.  Interest, (1% of License Fees past due per month until paid)……
9.  Penalty, (10% of License Fees past due)………………………….
10.  Total, Lines 7,8 and 9………………………………………………………………………………
11.  Less Minimum Payment Paid…………………………………………………………………………
12.  Less Estimated Payment Paid……………………………………………………………………….
13.  Balance due (Line 10 minus line 11)…………………………………………………………………
				*Exclusive if the Principal Business Activity is not Investments
				SCHECULE 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…………………………………..
……………………………………………………………………
……………………………………………………………….
…MUST BE POSTMARKED BY APRIL 15TH ………………………….
…………………………………………………………………………..
…………………………….
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
Signature of Preparer				Date	Flemingsburg.  For more information
					call (606) 845-5951.
Signature of Taxpayer				Date