MARSHALL COUNTY OCCUPATIONAL LICENSE TAX
FOR GENERAL OUTLAY PURPOSES
WITHHOLDING APPLICATION
COLLECTOR: MARSHALL COUNTY OCCUPATIONAL LICENSE TAX ADMIN.
P.O. BOX 114 |
PHONE |
(270) 527-4725 |
1101 MAIN STREET |
FAX |
(270) 527-3194 |
BENTON, KY 42025 |
EMAIL |
emily.martin@ky.gov |
INSTRUCTIONS: This form is to be filled out and submitted to the above address by all businesses having employees within Marshall County, Kentucky, and shall be used as a basis for issuance of a withholding account identification number.
1.BUSINESS NAME: _______________________________CONTACT: _______________________
2.BUSINESS ADDRESS: ______________________________________________________________
3.ADDRESS FOR QTRLY TAX RETURNS: ______________________________________________
4.ADDRESS FOR ANNUAL TAX RETURNS: ____________________________________________
5.PHONE: a) _________________________________ b) ____________________________________
6.FAX: a) ____________________________________ b) ____________________________________
7.EMAIL: a) __________________________________ b) ____________________________________
8.TYPE OF OWNERSHIP: ___ INDIVIDUAL; ___ PARTNERSHIP; ___ CORPORATION; ___ LLC;
___ OTHER: ______________________ **Check box if NOT subject to federal income tax 

9.IF INDIVIDUAL/PARTNERSHIP LIST NAME & ADDRESS OF OWNER/PARTNERS:
a.___________________________________________________ SSN: ____________________
b.___________________________________________________ SSN: ____________________
c.___________________________________________________ SSN: ____________________
10.DATE BUSINESS FIRST PAID WAGES TO EMPLOYEES IN MARSHALL CO. ______________
11.FEDERAL ID: _____________________________ STATE ID:_______________________________
12.DATE TAXABLE YEAR ENDS: ______________________________________________________
13.NATURE OF BUSINESS: ____________________________________________________________
14. BUSINESS IS LOCATED IN MARSHALL CO. DISTRICT: # 1 |
# 2 |
#3 |
I hereby certify that all information and statements herein are true and correct. |
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Signature |
Title: Owner, Partner, President, etc. |
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Date |
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DO NOT WRITE IN THIS SPACE |
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ACC# __________ |
Date Opened: ___________________________ or Reassigned ___________________ From #________
Date Account Closed: ________________________ Reason: ________________________________