Kentucky Tax Application Form

Kentucky Tax Registration Application and Instructions

Commonwealth of Kentucky Department of Revenue

For Office Use Only

SECTION A — REASON FOR COMPLETING THIS APPLICATION

1. Effective Date:

2. Previous Account Numbers (if applicable):

Reason for Completing This Application:

Opened new business / Began activity in Kentucky

Resumption of business

Hired employees working outside KY who have a KY residence

Applying for other accounts / Began a new taxable activity

Bidding for State Government Contract (State Vendor or Affiliates)

Purchased an existing business

Business structure change or conversion

Change in FEIN / KY SOS Organization Number / CBI

Other:

SECTION B — BUSINESS / RESPONSIBLE PARTY / CONTACT INFORMATION

3. Legal Business Name:

4. Doing Business As Name:

5. Federal Employer Identification Number (FEIN):

6. Kentucky Commonwealth Business Identifier (CBI):

7. Kentucky Secretary of State Organization Number:

Date of Incorporation / Organization:

State of Incorporation / Organization:

Date of Qualification (if out-of-state entity):

8. Primary Business Location

9. Accounting Period

Calendar Year

Fiscal Year:

52/53 Week Calendar Year

52/53 Week Fiscal Year

10. Accounting Method

Cash

Accrual

11. Business Structure

Profit Limited Liability Company (LLC)

Non-Profit Limited Liability Company (LLC)

Professional Limited Liability Company (PLLC)

Series of a Limited Liability Company

Profit Corporation

Non-Profit Corporation

Professional Service Corporation (PSC)

Cooperative Corporation

Limited Cooperative Association

Association

Statutory Trust

Series of a Statutory Trust

Business Trust

Trust (Non-statutory)

Limited Partnership (LP)

Limited Liability Partnership (LLP)

Limited Liability Limited Partnership (LLLP)

Series of a Partnership

General Partnership

Joint Venture

Estate

Government

Unincorporated Non-profit Association

Sole Proprietorship

Home Care Service Recipient (HCSR)

Qualified Joint Venture (Married Couple)

Protected Cell Company (PCC)

Cell of a Protected Cell Company

Other:

12. How Will You Be Taxed for Federal Purposes?

Partnership

Corporation

S-Corporation

Cooperative

Trust

Single Member Disregarded Entity

Other:

13-14. Ownership Disclosure / Responsible Parties

15. Person to contact about this application

SECTION C — TELL US ABOUT YOUR BUSINESS OR ORGANIZATION

16. Business Activity Description

Business operations are primarily: Home Based Web Based Office/Store Based Transient

Questions 17–21

17. Do you have or will you hire employees to work in Kentucky within the next 6 months? Yes No

18. Do you wish to voluntarily withhold on Kentucky residents who work outside Kentucky? Yes No

19. Do you wish to voluntarily withhold on pension and retirement payments? Yes No

20. If your business is choosing taxation as a corporation for Federal purposes, will Kentucky officers receive compensation other than dividends? Yes No

21. Will your business be registered to make charitable or other lawful gaming payouts in Kentucky and be required to withhold Federal tax from those payouts? Yes No

Questions 22–35

22. Will you make retail and/or wholesale sales of tangible personal property or digital property in Kentucky? Yes No

23. Will you install replacement parts for the repair or recondition of tangible personal property? Yes No

24. Will you produce, fabricate, process, print or imprint tangible personal property? Yes No

25. Will you rent or lease tangible personal property or digital property to others, including related companies? Yes No

26. Will you charge taxable admissions? Yes No

27. Will you rent temporary lodging to others? Yes No

28. Will you sell for or are you a manufacturer’s agent soliciting orders for a nonresident seller not registered in Kentucky? Yes No

29. Will you receive receipts from the breeding of a stallion to a mare in Kentucky? Yes No

30. Will you make sales of motor vehicles to residents of AZ, CA, FL, IN, MA, MI, SC, or WA? Yes No

31. Will you make sales of aviation jet fuel? Yes No

32. Are you a manufacturing fee processor or a contract miner located in Kentucky? Yes No

33. Are you bidding on a contract with Kentucky state government to be a state vendor? Yes No

34. Are you an affiliate of a company that has been awarded a Kentucky state government contract and is a state vendor? Yes No

35. Will you sell any of the following? A. Coal or other minerals B. Water utilities C. Natural, artificial, or mixed gas utilities D. Electricity E. Sewer services F. Communications services G. Multichannel video programming services H. Direct broadcast satellite services

SECTION D — EMPLOYER’S WITHHOLDING TAX ACCOUNT

54. Has a Kentucky Employer’s Withholding Tax Account already been assigned to this business? Yes No

54B. Employer’s Withholding Tax Account Number:

55. Number of Kentucky employees:

56. Date wages/pensions first paid or will be paid:

57. Estimated total annual tax withheld in Kentucky:

$0.00–$399.99

$400.00–$1,999.99

$2,000.00–$49,999.99

$50,000.00 or more

58. Is withholding reported by a Common Paymaster or Common Pay Agent? Yes No

Common Paymaster Common Pay Agent

SECTION E — SALES AND USE TAX ACCOUNT / TRANSIENT ROOM TAX / MOTOR VEHICLE TIRE FEE

60. Has a Kentucky Sales and Use Tax Account already been assigned to this business? Yes No

60B. Sales and Use Tax Account Number:

61. Date sales began or will begin:

62. Do you rent temporary lodging to others? Yes No

63. Do you sell new tires for motor vehicles? Yes No

64. Estimated gross monthly sales tax collected in Kentucky:

$0.00–$199.99

$200.00–$1,199.99

$1,200.00 or more

65. Does this business have additional locations in Kentucky? Yes No

66. Sales and Use Tax returns should be mailed to the following address:

Use the same address as listed on Page 2, Section B, Question 8

SECTION F — UTILITY GROSS RECEIPTS LICENSE TAX ACCOUNT

67. Has a Kentucky Utility Gross Receipts License Tax Account already been assigned to this business? Yes No

67B. Utility Gross Receipts License Tax Account Number:

68. Date sales of utilities began or will begin:

69. Telephone Number:

SECTION G — TELECOMMUNICATIONS TAX ACCOUNT

70. Has a Kentucky Telecommunications Tax Account already been assigned to this business? Yes No

70B. Telecommunications Tax Account Number:

71. Does your organization have tangible personal property located within Kentucky? Yes No

72. Date sales of communications began or will begin:

73. Telephone Number:

SECTION H — CONSUMER’S USE TAX ACCOUNT

74. Has a Consumer’s Use Tax Account already been assigned to this business? Yes No

74B. Consumer’s Use Tax Account Number:

75. Date purchases began or will begin:

76. Consumer’s Use Tax returns should be mailed to the following address:

Use the same address as listed on Page 2, Section B, Question 8

SECTION I — COAL SEVERANCE / PROCESSING TAX ACCOUNT AND/OR COAL SELLER / PURCHASER CERTIFICATE ID

77. Has a Coal Severance Tax Account and/or Coal Seller/Purchaser Certificate ID already been assigned to this business? Yes No

77B. Coal Severance Tax Account Number:

77C. Coal Seller/Purchaser Certificate ID Number:

78. Date mining/processing or coal brokering operations began or will begin:

79. Coal Severance & Processing Tax returns should be mailed to the following address:

Use the same address as listed on Page 2, Section B, Question 8

SECTION J — CORPORATION INCOME AND/OR LIMITED LIABILITY ENTITY TAX ACCOUNT

80. Has a Corporation Income and/or Limited Liability Entity Tax Account already been assigned to this business? Yes No

80B. Corporation Income or Limited Liability Entity Tax Account Number:

81. Is your entity exempt from Corporation Income Tax and/or Limited Liability Entity Tax? Yes No

81B. Exemption type:

81C. If political organization selected, are you required to file Federal Form 1120-POL? Yes No

82. Is this entity treated federally as a division of a parent company and not separately taxed? Yes No

82B. Division type: Qualified Subchapter S-corporation Subsidiary (QSUB) Qualified Real Estate Investment Trust Subsidiary (QRS)

83. If out-of-state entity, is Kentucky activity limited to mere solicitation and exempt from corporation income tax? Yes No

84. If out-of-state entity, date activity or receipt of pass-through income began or will begin:

85. Corporation Income and/or Limited Liability Entity Tax correspondence should be mailed to:

Use the same address as listed on Page 2, Section B, Question 8

SECTION K — KENTUCKY NONRESIDENT INCOME TAX WITHHOLDING ON DISTRIBUTIVE SHARE INCOME TAX ACCOUNT

86. Has a Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account already been assigned to this business? Yes No

86B. Kentucky Nonresident Income Tax Withholding Account Number:

87. Is your entity exempt from Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax? Yes No

87B. Exemption type:

88. Date first nonresident corporation or individual became a partner, member, or shareholder:

89. Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax correspondence should be mailed to:

Use the same address as listed on Page 2, Section B, Question 8

The statements contained in this application and any accompanying schedules are hereby certified to be correct to the best knowledge and belief of the undersigned who is duly authorized to sign this application.

IMPORTANT: THIS APPLICATION MUST BE SIGNED BELOW