Kentucky Retirement Systems 6230/J356 Perimeter Park West l1260 Louisville Rd. l Frankfort KY 40601-6124 Phone: (502) 696-8800 l Fax: (502) 696-8822 l kyret.ky.gov Penalty Invoice Employer Information Employer Name: CITY OF WEST BUECHEL Address: 3705 BASHFORD AVE Employer Code: J356 City: WEST BUECHEL State: KY Zip Code: 402182509 Invoice Details Invoice Number: 204240 Due Date: 7/16/2016 Report Month: 05/01/2016 Summary Received: 06/16/2016 Contributions Received: 06/16/2016 Detail Received: 06/16/2016 Amount Due: $1,000.00 Payment Instructions In accordance with Kentucky Revised Statuses 61.675 and 78.625, retirement contributions and accompanying reports(s) are due at Kentucky Retirement System on, or before, the 10th day of the month following the period being reported. When the retirement contributions and accompanying report(s) fail to reach us by the due date, a minimum penalty of $1,000 is assessed. Your agency has been assessed this penalty. Please select this invoice for payment to be included with your next monthly Contribution Report. This invoice can be selected as part of the Summary submission process. You may alternatively remit a check or money order payable to the Kentucky State Treasurer. Please include your Employer ID and the Invoice Number listed above on your check or money order. Mail your payment and this voucher to our office at 1260 Louisville Road, Frankfort, Kentucky 40601. If you disagree with this notice, please respond directly to Todd Coleman, Controller in writing and include all applicable information to support your explanation. Should you have any questions regarding this notice, please telephone him directly at (502) 696-8453, or send an electronic mail message to todd.coleman@kyret.ky.gov. Kentucky Retirement Systems 6230/J356 Perimeter Park West l1260 Louisville Rd. l Frankfort KY 40601-6124 Phone: (502) 696-8800 l Fax: (502) 696-8822 l kyret.ky.gov Penalty Voucher Employer Information Employer Name: CITY OF WEST BUECHEL Address: 3705 BASHFORD AVE Employer Code: J356 City: WEST BUECHEL State: KY Zip Code: 402182509 Payment Details Invoice Number: 204240 Due Date: 7/16/2016 Amount Due: $1,000.00 For KRS Use Only CERSHZ PENALTYMTH $1,000.00