Employers Annual Reconciliation of License Fee Withheld

HOW TO RECONCILE YOUR PAYROLL AND WITHHOLDINGS

Enter under TOTAL PAYROLL the quarterly totals of all compensation paid for all employees. Deduct any payments for services
performed outside the City of Pikeville and enter balance in SUBJECT PAYROLL column, SUBJECT PAYROLL includes all
compensation, i.e. Vacation and Holiday pay etc.

ATTACH COPIES OF FEDERAL FORMS W-2’S AND W-3 AS FILED WITH SOCIAL SECURITY ADMINISTRATION

EMPLOYERS WITH PAYROLL BOTH INSIDE/OUTSIDE THE CITY OF PIKEVILLE ARE REQUIRED TO ATTACH A LISTING OF THE
TAXABLE WAGES APPLICABLE TO THE CITY OF PIKEVILLE IF WAGES ARE NOT SHOWN SEPARATELY ON THE W-2 FORMS.

COMPUTER PRINTOUTS WILL NOT BE ACCEPTED IN PLACE OF W-2S.

AMOUNT FROM EMPLOYER’S QUARTERLY RETURN FORM EQ-1

1st Quarter ended March 31

2nd Quarter ended June 30

3rd Quarter ended Sept 30

4th Quarter ended Dec 31

Total all Quarters

Number of Employees:

ALL RETURNS RECEIVED WITHOUT W-2 FORMS, W-3 FORM AND SIGNATURE WILL BE ASSESSED A $20.00 SERVICE CHARGE.
NOTICE: THIS FORM MUST BE RETURNED WHETHER OR NOT YOU HAD EMPLOYEES DURNING THE YEAR. A PENALTY OF $25.00 APPLIES FOR
FAILURE TO FILE THIS FORM BY DUE DATE.

Once you have submitted this application, the City will contact you regarding its status and any fees or additional information that may be required. Please contact the Tax Administration Office at 606-437-5100 with any questions or concerns.