Questionnaire
to be completed in order to establish an account for reporting
OCCUPATIONAL LICENSE FEES
for ALLEN COUNTY, KENTUCKY

Every business or individual subject to the Occupational License Fee is required to complete this questionnaire and return it to the Administrator (submitting this form will e-mail your information to the administrator of Allen County Kentucky) . There are no required fields, but please ANSWER ALL APPLICABLE QUESTIONS.

According to an opinion (OAG 85-1) of Kentucky's Attorney-General the responses which you make to questions 1, 2, 3A (principal business location) and 6 below are to be provided to anyone, upon request, pursuant to the Kentucky "Open Records Law".

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1.
Name
(Please check one box)

Individual

Partnership (list name and address of each partner on line 11.)
Corporation (Date organized Month / Day / Year
State )
Other - Please give description:
2.
Trade Name
(if different from that given on line 1.)
3.
Addresses
 (Please complete all addresses applicable - indicate Zip Code and Telephone Number)
A. County Address
(If more than one location in Allen County, list on line 11.)
Telephone Number
B. Mailing Address (If different from above)
Telephone Number
4.
Accounting Period
 Calendar Year - Dec. 31
(Please check one box)
 Fiscal Year Ended ( Month / Day)
5.
State Tax Identification Number
If individual, give Social Security Number
6.

Nature of Business

(Please describe your business and its operation, including where and how sales, services, or other activities take place. Include any other pertinent information.)
7.
Date Operations in Allen County Started
 (Month / Day / Year)
8.
Do you have or will have employees working in Allen County?
 Yes No
A. Number of Employees
B. Estimated Quarterly Payroll
Date of employment in these areas was first given or will be given
(Month / Day / Year)
9. Do you have or will you have receipts from an occupation or business activity in Allen County? Yes No
10. If business was obtained from a previous owner, or a change in type of organization:
a) Give date of Acquisition or Change
b) Give name of Previous Owner or Organization
c) Give former Trade Name, if any
11. Other Information
Today's Date
I hereby certify that all information and statements herein are true and correct. Type name and title.