Kentucky Tax Registration Application and Instructions

Kentucky Tax Registration Application

and Instructions

www.revenue.ky.gov

COMMONWEALTH OF KENTUCKY

DEPARTMENT OF REVENUE

FRANKFORT, KENTUCKY 40620

10A100(P) (11-23)

Employer’s Withholding Tax Account

Sales and Use Tax Account/Permit

Transient Room Tax Account

Motor Vehicle Tire Fee Account

Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account

Utility Gross Receipts License Tax Account

Telecommunications Tax Account

Consumer’s Use Tax Account

Corporation Income Tax Account

Limited Liability Entity Tax Account

Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account

Coal Severance and Processing Tax Account

Coal Seller/Purchaser Certicate ID Number

10A100(P)(11-23)

Commonwealth of Kentucky

DEPARTMENT OF REVENUE

FOR OFFICE USE ONLY

CBI #

FEIN

CRIS #

RCS Flag

NAICS

Coded/Date Coded

Data Entry/Data Entered

 WH  SU  TEL CU  CT  CP  NRWH

 TR  UTL  CID LL

 TF

 CMRS

SECTION A REASON FOR COMPLETING THIS APPLICATION (Must Be Completed)

SECTION B BUSINESS / RESPONSIBLE PARTY / CONTACT INFORMATION (Must Be Completed)

4. Legal Business Name

5. Doing Business As (DBA) Name (See instructions)

6. Federal Employer Identication Number (FEIN)

(Required, complete prior to submitting)

7. Kentucky Commonwealth Business Identier

(if already assigned)

8. Secretary of State Information (if applicable)

Kentucky Secretary of State Organization Number

/ /

Date of Incorporation/Organization State of Incorporation/Organization

/ /

If you are an Out-of-State Entity, Date of

Qualication with the Kentucky Secretary of

State’s Oce

—

1. Eective Date 3. Previous Account Numbers (If applicable)

 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 Aliates)

 Purchased an existing business (See instructions)

Purchased business assets from previous owner

 Yes  No

 Business structure change or conversion

(Specify previous type; See instructions)

 Change of Federal Identication Number (FEIN), Kentucky

Secretary of State Organization Number, or Commonwealth

Business Identier (CBI)

 Other (Specify)

/ /

Kentucky Employer’s Withholding Tax __________________

Kentucky Sales and Use Tax __________________

Kentucky Telecommunications Tax __________________

Kentucky Utilities Gross Receipts License Tax __________________

Kentucky Consumer’s Use Tax __________________

Kentucky Corporation Income Tax and/or

Limited Liability Entity Tax __________________

Kentucky Coal Severance & Processing Tax __________________

Kentucky Pass-Through Non-Resident Withholding __________________

Federal ID Number (FEIN) __________________

Kentucky Secretary of State Organization Number __________________

Commonwealth Business Identier (CBI) __________________

 Incomplete or illegible applications will delay processing and will be returned.

 See instructions for questions regarding completion of the application.

 Need Help? Call (502) 564-3306 or

Email DOR.Registration@ky.gov

KENTUCKY TAX REGISTRATION APPLICATION

For faster service, apply online at

http://onestop.ky.gov

To update information for your existing account(s) or report opening a new location of your current business,

use Form 10A104, Update or Cancellation of Kentucky Tax Account(s).

2. A. Did you receive correspondence from the Division of Registration requesting registration of this business?

 Yes  No

B. If Yes, enter the File Number(s) located at the

top of the letter you received.

File Number File Number



13. Business Structure

14. How Will You be Taxed for Federal Purposes?

(Sole Proprietorships, HCSRs, Qualied Joint Ventures, Estates, Governments, and Unincorporated Non-Prots SKIP question 14)

15–16. OWNERSHIP DISCLOSURE–RESPONSIBLE PARTIES (REQUIRED FOR ALL BUSINESS STRUCTURES)

 Prot Limited Liability

Company (LLC)

 Non-Prot Limited Liability

Company (LLC)

 Professional Limited Liability

Company (PLLC)

 Series of a Limited Liability

Company

 Prot Corporation

 Non-Prot 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-prot

Association

 Sole Proprietorship

 Home Care Service

Recipient (HCSR)

 Qualied Joint Venture

(Married Couple)

 Public Benet Corporation

 Other (Specify)

 Single Member Disregarded Entity



Partnership

 Corporation

 S-Corporation

 Cooperative

 Trust

Check below how the Member will be taxed federally

 Individual Sole Proprietorship

 General Partnership/Joint Venture

 Estate

 Trust (Non-statutory)/Business Trust

 Other (Specify how the Member is federally taxed)

10A100(P)(11-23) Page 2

Full Legal Name (First Middle Last)

Social Security Number (REQUIRED) FEIN (if Responsible Party is another business)

Driver’s License Number (if applicable) Driver’s License State of Issuance

Business Title Eective Date of Title

Residence Address

City State Zip Code

Telephone Number County (if in Kentucky)

( ) –

/ /

Full Legal Name (First Middle Last)

Social Security Number (REQUIRED) FEIN (if Responsible Party is another business)

Driver’s License Number (if applicable) Driver’s License State of Issuance

Business Title Eective Date of Title

Residence Address

City State Zip Code

Telephone Number County (if in Kentucky)

( ) –

/ /

9. Primary Business Location 11. Accounting Period

( ) –

 Calendar Year: Year Ending December 31

 Fiscal Year: Year Ending ___ ___ /___ ___ (mm/dd)

 52/53 Week Calendar Year: _______________________________

(Month and Day of Week Year Ends)

 52/53 Week Fiscal Year: _______________________________

(Month and Day of Week Year Ends)

12. Accounting Method

 Cash Accrual

Street Address (DO NOT List a PO Box)

City State Zip Code

Telephone Number County (if in Kentucky)

10. Business Operations are Primarily

 Home Based  Web Based  Oce/Store Based  Transient

See instructions regarding required responsible parties for your business structure

SECTION C TELL US ABOUT YOUR BUSINESS OR ORGANIZATION (Must Be Completed)

10A100(P)(11-23) Page 3

Name (First Middle Last) Title Daytime Telephone Extension

E-mail: (By supplying your e-mail address you grant the Department of Revenue permission to contact you via e-mail.)

( ) –

17. Person to contact about this application:

18a. Describe the nature of your business activity in Kentucky, including any services provided.

_________________________________________________________________________________________________________________________

18b. List products sold in Kentucky.

_________________________________________________________________________________________________________________________

18c. Please list the NAICS (North American Industry Classication System) Code used to classify your business, if known. _____________________

The following questions will determine your need for a Sales and Use Tax Account,

the schedules you may need to le,

and/or your need for a

Transient Room Tax Account,

Motor Vehicle Tire Fee Account,

Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account,

Utility Gross Receipts License Tax Account, and/or

Telecommunications Tax Account.

CONTINUE



Sales and Use Tax Account

Yes No

23. Will you make retail and/or wholesale sales of tangible or digital property in Kentucky? .................................................................................  

Examples: prepared food, internet sales, downloaded music and books. (See instructions for more.)

24. Will you install replacement parts for the repair or recondition of tangible property? .......................................................................................  

Examples: automotive repairs, computer or electronics repair, furniture repair. (See instructions for more.)

25. Will you produce, fabricate, process, print or imprint tangible property? ..........................................................................................................  

Examples: sign making, window tinting, embroidery, screen printing, engraving. (See instructions for more.)

26.

Will you charge for labor or services rendered in installing or applying tangible personal property, digital property, or service sold?

...............  

CONTINUED ON NEXT PAGE

The following questions will determine your need for an Employer’s Withholding Tax Account.

Yes No

19. Do you have or will you hire employees to work in Kentucky within the next six (6) months? .........................................................................  

An employee is anyone to whom you pay wages, including part-time help and family members. Kentucky corporate

ocers receiving compensation other than dividends are also considered employees.

20. Do you wish to voluntarily withhold on Kentucky residents who work outside Kentucky? ...............................................................................  

21.

Do you wish to voluntarily withhold on pension and retirement payments? .....................................................................................................  

22. 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? .......................................................................................................................................................................  

If you answered Yes to any of questions 19 through 22, you must complete SECTION D.

10A100(P)(11-23) Page 4

Yes No

  A. Landscaping services

  B. Janitorial services

  C. Small animal veterinary services

  D. Pet care services

  E. Industrial laundry services

  F. Non-coin operated laundry and dry

cleaning services

  G. Linen supply services

  H. Indoor skin tanning services

  I. Non-medical diet and weight reducing

services

  J. Photography and photo nishing

services

  K. Telemarketing services

  L. Public opinion and research polling services

  M. Lobbying services

  N. Executive employee recruitment services

  O. Website design and development services

  P. Website hosting services

  Q. Private mailroom services (including

presorting, bar coding, tracking delivery

to postal service, and private mailbox rentals)

  R. Bodyguard services

  S. Residential and non-residential security

system monitoring services

  T. Private investigation services

  U. Process Server Services

  V. Repossession of tangible personal property

services

  W. Personal Background Check services

  X. Parking services (including valet services and

the use of parking lots and parking structures,

excluding any parking at an educational

institution)

  Y. Road and travel services provided by

automobile clubs

  Z. Condominium time-share exchange services

Yes No

 AA. Rental of space for meetings, conventions,

short-term business uses, entertainment

events, weddings, banquets, parties, and

other short-term social events

 AB. Social event planning and coordination

services

 AC. Leisure, recreational, and athletic instructional

services

 AD. Recreational camp tuition and fees

 AE. Personal tness training services

 AF. Massage services, unless medically

necessary

 AG. Cosmetic surgery services

 AH. Body modication services that are not

necessary for medical or dental health,

such as tattooing, etc.

  AI. Laboratory testing services, except for medical,

educational, or veterinary reasons

 AJ. Interior decorating and design services

 AK. Household moving services

 AL. Specialized design services, including the

design of clothing, costumes, fashion, furs,

jewelry, shoes, textiles, and lighting

 AM. Lapidary services, including cutting, polishing,

and engraving precious stones

 AN. Labor and services to repair or maintain

commercial refrigeration equipment or systems

 AO. Labor to repair or alter apparel, footwear,

watches, or jewelry

 AP. Pre-written computer software access services

27. Will you provide any of the following services? (See instructions for more.)

CONTINUED ON NEXT PAGE

10A100(P)(11-23) Page 5

Yes No

  A. Sewer services

  B. Water utilities

  C. Natural, articial, or mixed gas utilities

  D. Electricity

Yes No

  E. Communications services

  F. Multichannel video programming services *(see instructions)

  G. Video streaming services *(see instructions)

  H. Direct broadcast satellite services *(see instructions)

If you answered Yes to any of questions 23 through 45 E, you must complete SECTION E.

If you answered Yes to any of questions 44 or 45 B through 45 G, you must complete SECTION F.

If you answered Yes to any of questions 45 E through 45 H, you must complete SECTION G.

Transient Room Tax Account

41. Will you rent temporary lodging (less than 30 continuous days) to others? .....................................................................................................  

Examples: hotel, motel, inn, campground, or RV park (See instructions for more.)

Motor Vehicle Tire Fee Account

42. Will you sell new tires for motor vehicles or semi-trailers? ...............................................................................................................................  

Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account

43. Will you sell cellular phones with preloaded minutes, prepaid cellular phone cards, or recharge cellular phones and cards

with minutes? ...................................................................................................................................................................................................  

Utility Gross Receipts License Tax Account and/or Telecommunications Tax Account

44. Were you approved for an Energy Direct Pay Authorization with a Utility Gross Receipts License Tax Exemption? ......................................  

Attach a copy of your ocial UGRLT Exemption Authorization.

45. Will you sell any of the following?

Yes No

46a. Will your company purchase any of the utility types listed above in question 45 B through G from

a provider outside of Kentucky? .......................................................................................................................................................................  

46b. If yes, please list the provider’s name and utility type: _____________________________________________________________________

CONTINUE



Yes No

28. Will you sell extended warranties? ...................................................................................................................................................................  

29. Will you rent or lease tangible or digital property to others, including related companies? ..............................................................................  

30. Will you charge admissions, including initiation fees, monthly fees or membership fees for the use of a facility or participating

in an event or activity? (Non-prot organizations selling admissions other than golf admissions, check NO. (See instructions

for additional information.) ............................................................................................................................................................................  

31. Are you a remote retailer selling tangible personal property or digital property delivered or transferred electronically to a

purchaser in Kentucky? (See instructions for additional information.) .......................................................................................................  

32. Are you a manufacturer’s agent soliciting orders for a nonresident seller not registered in Kentucky? ...........................................................  

33a. Are you a marketplace provider or retailer? (See instructions for additional information.) ........................................................................  

33b. Do you facilitate sales by third party retailers? (See KRS 139.450. A marketplace provider may register for two Kentucky sales

tax account numbers. See instructions for additional information.) ...........................................................................................................  

33c. Are you applying for separate accounts for your own sales and for your facilitated sales? (See instructions for additional

information.) ...................................................................................................................................................................................................  

34. Are you a manufacturing fee processor or a contract miner operating in Kentucky? .......................................................................................  

35. Are you bidding on a contract with Kentucky state government? .....................................................................................................................  

36. Are you an aliate of a company who has been awarded a Kentucky state government contract? ...............................................................  

37. Will you rent campsites at campgrounds or recreational vehicle parks? ..........................................................................................................  

Sales and Use Tax Account Schedules

38. Will you receive receipts from the breeding of a stallion to a mare in Kentucky? ............................................................................................  

39. Will you make sales of aviation jet fuel? ...........................................................................................................................................................  

40a. Will you make sales of motor vehicles to residents of Arizona, California, Florida, Indiana, Massachusetts, Michigan, South

Carolina, or Washington? .................................................................................................................................................................................  

40b. Will you make sales of recreational vehicles to customers that are residents of Arizona, California, Florida, Hawaii, Massachusetts,

Michigan, North Carolina, South Carolina, and Wisconsin? .............................................................................................................................  

The following questions will determine your need for a

Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account.

Yes No

55. Is this business considered a pass-through entity as dened in KRS 141.010(22)? .......................................................................................  

56. Does your pass-through entity have nonresident:

Yes No

A. Individual partner(s), shareholder(s), or member(s) receiving Kentucky distributive share income from your

pass-through entity? .................................................................................................................................................................................  

“Individual" includes estates and trusts.

B. Corporate partner(s) or member(s) receiving Kentucky distributive share income from your pass-through entity? ................................  

If you answered Yes to question 56 A and/or 56 B, you must complete SECTION J.

If you answered Yes to question 55, you must answer questions 56 A and 56 B.

CONTINUE



CONTINUE



CONTINUE



The following questions will determine your need for a

Corporation Income Tax Account and/or a Limited Liability Entity Tax Account.

If you answered Yes to any of questions 48 through 54, you must complete SECTION I.

If your answer to questions 13 and 14 was NOT

Sole Proprietorship, HCSR, Qualied Joint Venture, Estate, Government,

General Partnership taxed as a Partnership, or Joint Venture taxed as a Partnership,

you must complete questions 48 through 54.

Yes No

48. Are you organized under the laws of Kentucky with the Kentucky Secretary of State’s Oce? ......................................................................  

49. Will your business have its commercial domicile in Kentucky? ........................................................................................................................  

50. Will your business own or lease any real or tangible property in Kentucky? ....................................................................................................  

51. Will your business have one or more individuals performing services in Kentucky? .......................................................................................  

52. Will your business maintain an interest in a pass-through entity or derive income from Kentucky sources? ..................................................  

53. Will you direct activities toward Kentucky customers for the purpose of selling them goods and/or services? ...............................................  

54. Will your business own/lease any intangible property or receive payments from a related member as dened in KRS 141.205(1)(g)

or an unrelated party for the use of intangible property in Kentucky such as royalties, franchise agreements, patents, trademarks,

etc.? .................................................................................................................................................................................................................  

The following question will determine your need for a Consumer’s Use Tax Account.

Skip question 47 if you must complete Section E.

If you answered Yes to question 47, you must complete SECTION H.

Yes No

47. Will your business make purchases from out-of-state vendors and not pay Kentucky Sales or Use Tax to the seller on those purchases? ..  

If you are a PROFESSIONAL SERVICE business or if your business will make a one-time purchase only, please see

instructions for important additional details.

10A100(P)(11-23) Page 6

The following questions will determine your need for a

Coal Severance/Processing Tax Account and/or a Coal Seller Purchaser Certicate ID#.

If you answered Yes to any of questions 57 through 59, you must complete SECTION K and SECTION E.

Yes No

57. Will you mine coal to which you own or possess the mineral rights? ...............................................................................................................  

58. Will you purchase coal for the purpose of processing and resale, or do you process refuse coal? .................................................................  

Processing means cleaning, breaking, sizing, dust allaying, treating to prevent freezing, or loading or unloading for any purpose.

59. Will you purchase and sell coal as a coal broker? ...........................................................................................................................................  

10A100(P)(11-23) Page 7

SECTION D EMPLOYER’S WITHHOLDING TAX ACCOUNT

Must be completed if you answered Yes to any of questions 19 through 22.

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

B. If Yes, list the Employer’s Withholding Tax Account Number

61. Number of Kentucky employees ______________________________

62. Date wages/pensions rst paid or will be paid (REQUIRED)

63 Estimated total annual tax withheld in Kentucky:

$0.00–$399.99  $2,000.00–$49,999.99

$400.00–$1,999.99  $50,000.00 or more

64. A. Is the withholding for your employees reported by a Common Paymaster or a Common Pay Agent?  Yes  No

Most payroll processors do NOT operate as Common Paymasters/Pay Agents. If using a payroll processor, check with them to

determine if you should answer yes to the question above.

B. If Yes, attach a separate sheet listing which you use, Common Paymaster or Common Pay Agent, and provide their Business Name, FEIN, and

Kentucky Employer’s Withholding Tax Account Number.

/ /

c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)

( ) –

65. Employer’s Withholding Tax mailing address:

 Use the same address as your location address

 Use the same address as ______________________ Tax Account

10A100(P)(11-23) Page 8

SECTION E SALES AND USE TAX ACCOUNT

TRANSIENT ROOM TAX ACCOUNT

MOTOR VEHICLE TIRE FEE ACCOUNT

COMMERCIAL MOBILE RADIO SERVICE (CMRS) PREPAID SERVICE CHARGE ACCOUNT

Must be completed if you answered Yes to any of questions 23 through 45 E or any of questions 57 through 59.

67. Date sales began or will begin (REQUIRED)

68. Estimated gross monthly sales tax collected in Kentucky:

$0.00–$1,199.99  $1,200.00 or more

69. A. Does this business have additional locations in Kentucky other

than the Primary Business Location?  Yes  No

B. If Yes, attach a listing of all additional Kentucky locations. For each

location, the attachment should include: doing business as (DBA)

name, physical location address, phone number, date location was

opened, and a description of the location’s business activity.

/ /

c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)

( ) –

c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)

( ) –

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

B. If Yes, list the Sales and Use Tax Account Number

70. Sales and Use Tax mailing address:

 Use the same address as your location address

 Use the same address as _______________________ Tax Account

74. Utility Gross Receipts License Tax mailing address:

 Use the same address as your location address

 Use the same address as _______________________ Tax Account

SECTION F UTILITY GROSS RECEIPTS LICENSE TAX ACCOUNT

Must be completed if you answered Yes to any of questions 44 or 45 B through 45 G.

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

B. If Yes, list the Utility Gross Receipts License Tax Account Number

72. Date sales or purchases of utilities began or will begin (REQUIRED)

73. Telephone Number

/ /

(__________) __________ – ____________________

Once the account for Utility Gross Receipts License Tax is assigned,

use the website below to set up account for e-le.

http://revenue.ky.gov/Business/Utility-Gross-Receipts-License-Tax/Pages/default.aspx

10A100(P)(11-23) Page 9

82. Date purchases began or will begin

(REQUIRED)

/ /

c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)

( ) –

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

B. If Yes, list the Consumer’s Use Tax Account Number

83. Consumer’s Use Tax mailing address:

 Use the same address as your location address

 Use the same address as _______________________ Tax Account

SECTION H CONSUMER’S USE TAX ACCOUNT

Must be completed if you answered Yes to question 47.

SECTION G TELECOMMUNICATIONS TAX ACCOUNT

Must be completed if you answered Yes to any of questions 45 E through 45 H.

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

B. If Yes, list the Telecommunications Tax Account Number

76. Does your organization have tangible personal property located within the Commonwealth of Kentucky?  Yes  No

77. Select company type:

Municipal Entity  Other Provider  Consumer

78. Date sales of services began or will begin in Kentucky (REQUIRED)

79. Telephone Number

/ /

(__________) __________ – ____________________

Once the account for Telecommunications Tax is assigned, use

the website below to set up account for e-le.

http://revenue.ky.gov/Business/Telecommunications-Tax/Pages/default.aspx

c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)

( ) –

80. Telecommunications Tax mailing address:

 Use the same address as your location address

 Use the same address as _______________________ Tax Account

10A100(P)(11-23) Page 10

SECTION J KENTUCKY NONRESIDENT INCOME TAX WITHHOLDING ON DISTRIBUTIVE SHARE

INCOME TAX ACCOUNT

Must be completed if you answered Yes to question 56 A and/or B.

90. A. Has a Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account already been assigned to this business?

 Yes  No

B. If Yes, list the Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account Number

91.

Date rst nonresident corporation or individual became a

partner, member, or shareholder (REQUIRED)

92. A. Is your entity exempt from Kentucky Nonresident Income Tax

Withholding on Distributive Share Income Tax under Kentucky

law?  Yes  No

B. If Yes, see Exemption Table 2 in the instructions to provide the

code for your Exemption Type.

__________________________________________________

/ /

c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)

( ) –

93. Nonresident Distributive Share Withholding Tax mailing address:

 Use the same address as your location address

 Use the same address as _______________________ Tax Account

89. Corporation Income and/or Limited Liability Entity Tax mailing address:

 Use the same address as your location address

 Use the same address as _______________________ Tax Account

/ /

SECTION I CORPORATION INCOME AND/OR LIMITED LIABILITY ENTITY TAX ACCOUNT

Must be completed if you answered Yes to any of questions 48 through 54.

c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)

( ) –

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

B. If Yes, list the Corporation Income or Limited Liability Entity Tax Account Number

85. A. Is this entity treated federally as a division of a parent company

and not separately taxed as its own entity?  Yes  No

B. If Yes, select the division type below:

 Qualied Subchapter S-corporation Subsidiary (QSUB)

 Qualied Real Estate Investment Trust Subsidiary (QRS)

86. If an out-of-state entity, is your Kentucky activity limited to the mere

solicitation of the sale of tangible personal property and exempt from

Corporation Income tax due to Public Law 86-272?  Yes  No

87. If an out-of-state entity, date activity or receipt of pass through income

began or will begin in Kentucky

88.

A. Is your entity exempt from Corporation Income Tax and/or Limited Liability Entity Tax under Kentucky law?  Yes  No

B. If Yes, see Exemption Table 1 in the instructions to provide the code for your Exemption Type. __________________________________________

C. If Political Organization selected above, are you required to le federal Form 1120-POL?  Yes  No

✔

10A100(P)(11-23) Page 11

The Kentucky Department of Revenue does not discriminate on the basis of race, color, national origin,

sex, age, religion, disability, sexual orientation, gender identity, veteran status, genetic information or

ancestry in employment or the provision of services.

For assistance in completing the application, please call the Division of Registration at (502) 564–3306, Monday through Friday between the hours of

8:00 a.m. and 5:00 p.m., Eastern Time, or you may use the Telecommunications Device for the Deaf at (502) 564-3058.

SEND completed application to: KENTUCKY DEPARTMENT OF REVENUE

DIVISION OF REGISTRATION

501 HIGH STREET, STATION 20

FRANKFORT, KENTUCKY 40602-0299

FAX: 502–227–0772

E-MAIL: DOR.Registration@ky.gov

If you would like to register for Electronic Funds Transfer (EFT), visit the Kentucky Department of Revenue website at http://revenue.ky.gov .

This form does not include registration with the Secretary of State, Unemployment Insurance, or Workers’ Compensation Insurance. For assistance,

please contact those oces at the telephone numbers below.

Secretary of State (502) 564–3490 Unemployment Insurance (502) 564–2272 Workers’ Compensation (502) 564–5550

IRS—FEIN (800) 829–4933

For assistance with other questions about starting a business in Kentucky, including special licensing and permitting requirements, business structure registration,

employer responsibilities, and business development resources, call the Business Information Clearinghouse at 1–800–626–2250 or visit the Kentucky Business

One Stop website at http://onestop.ky.gov .

SECTION K COAL SEVERANCE/PROCESSING TAX ACCOUNT and/or COAL SELLER/PURCHASER CERTIFICATE ID #

Must be completed if you answered Yes to any of questions 56 through 58.

95.

Date mining/processing or coal brokering operations began

or will begin (REQUIRED)

/ /

c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)

( ) –

94. A. Has a Coal Severance Tax Account and/or a Coal Seller/Purchaser Certicate ID # already been assigned to this business?  Yes  No

B. If Yes, list the Coal Severance Tax Account Number

C. If Yes, list the Coal Seller/Purchaser Certicate ID Number

96.

Coal Severance & Processing Tax mailing address:

 Use the same address as your location address

 Use the same address as _______________________ Tax Account

The statements contained in this application and any accompanying schedules are hereby certied to be correct to the best knowledge and belief of the

undersigned who is duly authorized to sign this application.

Signature: __________________________________________________ Printed Name: _______________________________________________

Phone Number: ______________________________________________ Title: ______________________ Date: ____/____/______

(mm/dd/yyyy)

IMPORTANT: THIS APPLICATION MUST BE SIGNED BELOW:

INSTRUCTIONS

KENTUCKY TAX REGISTRATION APPLICATION

10A100(P)(11-23)

Commonwealth of Kentucky

DEPARTMENT OF REVENUE

WHAT IS THE PURPOSE OF THE KENTUCKY TAX REGISTRATION APPLICATION?

This application is used to apply for any of the following: Employer’s Withholding Tax Account, Sales and Use Tax Account/Permit,Transient Room Tax Account,

Motor Vehicle Tire Fee Account, Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account, Telecommunications Tax Account, Utility Gross

Receipts License Tax Account, Consumer’s Use Tax Account, Corporation Income Tax Account, Limited Liability Entity Tax Account, Kentucky Nonresident Income

Tax Withholding on Distributive Share Income Tax Account, Coal Severance and Processing Tax Account, and/or Coal Seller/Purchaser Certicate ID Number.

DO I HAVE ANY OTHER DEPARTMENT OF REVENUE TAX REGISTRATION REQUIREMENTS?

Depending on the product or service your business provides, there may be other state taxes that apply to your business. Most of these require that you le a

special application/registration. To register for Tobacco Tax, Minerals or Natural Gas Severance Tax, Motor Fuels Tax, or any other miscellaneous taxes

or fees administered by the Department of Revenue, visit the Department’s website at www.revenue.ky.gov .

I ALREADY HAVE TAX ACCOUNTS, HOW DO I UPDATE MY ACCOUNT INFORMATION?

Complete FORM 10A104, UPDATE OR CANCELLATION OF KENTUCKY TAX ACCOUNT(S), to update information; such as business name, location or mailing

addresses, phone numbers, accounting period, responsible party information, and to report a taxing election change with the Internal Revenue Service (IRS) or

to request cancellation of your accounts. Visit www.revenue.ky.gov to obtain the form.

You may also update certain business and tax account information for the Department of Revenue and the Kentucky Secretary of State’s Oce online. If you do

not already have online access to your business, follow the steps below.

1. Go to onestop.ky.gov .

2. Click on the Dashboard Login at the top right of the page.

Note: The One Stop Business Services login page provides information on creating a user account, as well as portal security. You will also nd overview

information for the services the portal currently provides. This information is updated regularly to reect new services and notify you when additional agencies

join the portal.

3. Welcome to the Kentucky Online Gateway. Select that you are a citizen or business partner and click Create Account.

4. Complete your Kentucky Online Gateway user account. Once a user account has been created, an e-mail will be sent to you with further instructions to

activate the account and login. You must use the activation link in the e-mail prior to logging in to your account.

5. Once logged in, launch the Kentucky Business One Stop App.

6. Go to the Link My Business option. Click on the link provided within that webpage to obtain the Commonwealth Business Identier (CBI) and the Security

Token for the business.

Note: You will be able to provide information to gain immediate access to the business or request a letter be mailed, which contains your CBI and Security

Token. To gain secure access to the portal, each business has been assigned a unique Security Token, which is an enhanced security feature of the portal.

7. Once you have the CBI and Security Token for the business, the Link My Business option will require you to name at least one “One-Stop Portal Business

Administrator.” (This should be the business owner or a representative from the business.)

Note: The administrator can then delegate access to other individuals—for example, an attorney, accountant or manager. The administrator also determines

the appropriate authority level for delegates to make changes—this could include changes such as ling annual reports with the Secretary of State’s Oce,

changing the business address, or ling and paying taxes. Only the One Stop business administrator(s) can grant, approve, withdraw or revoke access to

the business.

For more information about registering and using the portal, visit onestop.ky.gov . For questions, please call the Kentucky Business One Stop Help Line at

(502) 564-5053.

WHO CAN I CALL WITH QUESTIONS ABOUT REGISTRATION?

For help completing the application, please call the Division of Registration at (502) 564-3306, Monday through Friday between the hours of 8:00

a.m. and 5:00 p.m., Eastern Time.

You may also use the Telecommunications Device for the Deaf, (502) 564-3058.

The Department of Revenue has an Ombudsman who serves as your advocate and is available to make sure your rights are protected. You may contact the

Ombudsman at (502) 564-7822.

WHEN SHOULD I FILE MY APPLICATION?

You are required to complete the application and le it with the Kentucky Department of Revenue at least 30 days before engaging in an activity that requires

the establishment of the following:

n Employer’s Withholding Tax Account (KRS 141.310) n Consumer’s Use Tax Account (KRS 139.310)

n Sales and Use Tax Account (KRS 139.200, 139.240) n Utility Gross Receipts License Tax Account (KRS 160.613)

n Transient Room Tax Account (KRS 142.400) n Telecommunications Tax Account (KRS 136.614 and 136.616)

n Motor Vehicle Tire Fee Account (KRS 224.50-868) n Coal Seller/Purchaser Certicate ID Number (KRS 143.037)

n Commercial Mobile Radio Service Prepaid Service Charge Account (KRS 65.7634)

10A100(P)(11-23) Page 2

Pass-Through Entities must complete the application to establish a Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account

(KRS 141.206) within 30 days of obtaining a Kentucky non-resident individual or corporate partner, member, or shareholder.

Corporations and Limited Liability Entities must complete the application to establish a Corporation Income Tax Account and/or a Limited Liability Entity Tax

Account (KRS 141.040, 141.0401):

IS MY APPLICATION COMPLETE?

Your application will not be considered complete unless it includes all required information specied on the form. This includes, but is not limited to, a Federal

Employer Identication Number and accurate Social Security Number(s), as appropriate. You are required to provide your Social Security Number on tax forms

per Section 405, Title 42, of the United States Code. This information will be used to establish your identity for tax purposes.

WHAT PENALTIES APPLY?

Failure to complete and le the required application in the specied time frames listed above shall subject you to applicable penalties as provided in

KRS 131.180.

HOW LONG WILL IT TAKE FOR MY ACCOUNT NUMBERS TO BE ASSIGNED?

Fully completed paper applications will be processed, barring seasonal workload increases, within 5 to 10 business days. Applications with missing or unclear

information requiring additional research may take longer. Those with extensive amounts of missing information will be returned by mail for further completion.

For faster service, apply online at onestop.ky.gov .

Note: If your business structure is not available as a selection online, you must submit a completed Kentucky Tax Registration Application by mail, fax, or e-mail.

LINE BY LINE APPLICATION INSTRUCTIONS

SECTION A—REASON FOR COMPLETING THIS APPLICATION

1. Eective Date—Enter the eective date of the reason you are completing this application. Check the box which corresponds to why the application is

being completed.

• Opened New Business, Began Activity in Kentucky, Resumption of Business, Hired Employees Working Outside Kentucky Who Have a

Kentucky Residence—Complete Sections A, B, and C to determine the accounts for which you are required to apply. For Resumption of Business, list

your previous account numbers in Section A, question 3.

• Applying for Other Accounts, Began a New Taxable Activity—If you require an account type that is not currently assigned to your business, complete

Sections A, B, and C to determine the additional accounts for which you are required to apply. If the questions in Section C lead you to complete a

Section for an account type you already have, write your current account number in the eld provided within the Section you are completing.

• Bidding for State Government Contract (State Vendor or Aliates)—Any vendor who contracts to sell, install, or provide services to the Commonwealth

of Kentucky or one of its agencies, or any aliate of a company who contracts to sell, install, or provide services to the Commonwealth, is required to

register for Kentucky Sales and Use Tax per KRS Chapter 45A, and collect and remit the Sales and Use Tax imposed by KRS Chapter 139. Complete

Sections A, B, and C to determine the accounts for which you are required to apply.

• Purchased an Existing Business—(This will include a business previously owned by a family member.)

If you are...

Kentucky formed

Formed out-of-state and you have obtained a Certicate of Authority to

transact business in Kentucky from the Kentucky Secretary of State

Formed out-of-state and you have NOT obtained a Certicate of Authority

to transact business in Kentucky from the Kentucky Secretary of State

Then your application should be led...

Within 30 days of formation with the Kentucky Secretary of State’s Oce

Within 30 days of obtaining a certicate of authority, provided that you

are treated as doing business in Kentucky under KRS Chapter 141

Within 30 days of rst engaging in activities that result in you being

treated as doing business in Kentucky under KRS Chapter 141

Note to persons buying a business: Any person buying a business may incur a sales tax liability on the purchase of the business assets or become personally

liable for the prior sales tax liability of the seller. It may be necessary for the purchaser to withhold a part of the sales price until verication has been furnished

by the seller that tax liabilities have been paid or do not exist. Therefore, it is important that anyone purchasing a business obtain a copy of Kentucky Revised

Statutes 139.670 and 139.680 to determine the tax consequences and potential liability in such transactions. Copies are available at www.revenue.ky.gov, by

writing the Oce of Sales and Excise Taxes, Department of Revenue, P.O. Box 181, Station 67, Frankfort, Kentucky 40602-0181, or by calling (502) 564-5170.

• Business Structure Change or Conversion, Change in Federal Identication Number (FEIN), Change in Kentucky Secretary of State Organization

Number, or Change in Commonwealth Business Identier (CBI)—A business may change its taxing election with the Internal Revenue Service

(IRS) and retain the same Kentucky tax account numbers. However, any change to an entity’s business structure, Federal Identication Number (FEIN),

Kentucky Secretary of State Organization Number, or Commonwealth Business Identier (CBI) requires that new accounts be applied for with the

Department of Revenue.

To change a taxing election, use Form 10A104, Update or Cancellation of Kentucky Tax Account(s), to provide the updated business and responsible

party information.

For all other business structure changes or conversions, for receiving a new Federal Identication Number (FEIN), for receiving a new Kentucky

Secretary of State Organization Number, or for receiving a new Commonwealth Business Identier (CBI), you must apply for new Kentucky tax

account numbers. List your old account numbers in Section A, question 3, and complete Sections A, B and C to determine the account(s) for which

you are required to re-apply.

Examples of conversions requiring a business apply for new accounts are:

n A Sole Proprietorship converting to a General Partnership and vice versa,

n A Corporation converting to a Limited Liability Company (LLC) and vice versa,

n A Limited Liability Company (LLC) converting to a Statutory Trust and vice versa, or

n Any ownership type converting to a Limited Liability Company (LLC) and vice versa.

2. Did you receive correspondence from the Division of Registration and Data Integrity—If you received a letter(s) requesting registration, check Yes and

list the File Number(s) from the letter in B. If No, leave B blank.

3. Previous Kentucky Account Numbers—If you have purchased an existing business, list the previous owner’s accounts, if available. If your current business

has changed business structures, received a new Federal Identication Number (FEIN), received a new Kentucky Secretary of State Organization Number, or

a new Commonwealth Business Identier (CBI) and your company must apply for new accounts or you have resumed an old business, list your old accounts

in Section A, question 3. A request in writing from the previous owner is required to cancel previous accounts.

10A100(P)(11-23) Page 3

If the business you purchased was a... Then...

Sole Proprietorship

n Joint Venture

n Qualied Joint Venture

n General Partnership

n Series of a Statutory Trust

n Limited Partnership (LP)

n Limited Liability Partnership (LLP)

n Limited Liability Limited Partnership (LLLP)

n Series of a Partnership

n Series of a Limited Liability Company (LLC)

n Protected Cell Company (PCC)

n Prot Corporation

n Prot Limited Liability Company (LLC)

n Professional Service Corporation (PSC)

n Professional Limited Liability Company (PLLC)

n Public Benet Corporation

n Association

n Cooperative Corporation

n Limited Cooperative Association

n Statutory Trust

n Business Trust

n Trust (non-statutory)

n Non-Prot Corporation

n Non-Prot Limited Liability Company (LLC)

n Unincorporated Non-Prot Association

You will need to apply for new accounts. List the previous owner’s

accounts in Section A, question 3, and complete Sections B and C to

determine the account(s) for which you are required to re-apply.

If the business structure, Federal Identi cation Number (FEIN), Secretar y

of State Organization Number, and Commonwealth Business Identier

(CBI) will all stay the same, DO NOT use the Kentucky Tax Registration

Application. Use Form 10A104, Update or Cancellation of Kentucky

Tax Account(s), to provide the updated business and responsible party

information or update your information online.

If:

–you are converting the purchased business to a new business structure,

–the Federal Identication Number (FEIN) has changed, or

–the Secretary of State Organization Number has changed, or

–the Commonwealth Business Identier (CBI) has changed,

you will need to apply for new accounts. List the previous owner’s

accounts in Section A, question 3, and complete Sections B and C to

determine the account(s) for which you are required to re-apply.

SECTION B—BUSINESS / RESPONSIBLE PARTY / CONTACT INFORMATION

4. Legal Business Name—Enter the complete legal business name for your business or organization.

Note: If the business is a Sole Proprietorship, do not include your personal name unless it is a part of the business name or you do not have a business

name. For example: John Smith’s Plumbing.

If the business is a Home Care Service Recipient (HCSR), the name of the business should be the rst, middle and last name of the disabled or elderly

individual with the acronym “HCSR” added to the end of the name. For example: “John Q Public HCSR”.

5. Doing Business As (DBA)—If your business or organization has a “doing business as” name, enter the name.

6. Federal Employer Identication Number (FEIN)—Enter the FEIN assigned to your business or organization by the Internal Revenue Service. If you are a

disregarded entity that is operating under your parent’s FEIN, DO NOT list your parent’s/member’s FEIN.

10A100(P)(11-23) Page 4

Business Structure Basic Denition

Prot Corporation

Non-Prot Corporation

Professional Service Corporation (PSC)

Public Benet Corporation

An organization chartered by law and recognized as having a legal existence as an entity separate from

its owners. It operates under the direction of duly elected ocers.

A Non-Prot Corporation is a special type of corporation formed for educational, charitable, social, religious,

civic, or humanitarian purposes.

A PSC is a special type of corporation formed to engage in specic types of licensed professional services

such as law, medicine, architecture, accounting, engineering, etc.

Prot Limited Liability Company (LLC)

Non-Prot Limited Liability Company

(LLC)

Professional Limited Liability Company

(PLLC)

Series of a Limited Liability Company

An organization of individuals chartered by law and operating under the direction of members or managers.

For US federal taxation purposes an LLC can be taxed as a single member disregarded entity, partnership,

or a corporation.

A Non-Prot LLC is a special type of LLC formed for educational, charitable, social, religious, civic or

humanitarian purposes.

A PLLC is a special type of LLC formed to engage in specic types of licensed professional services such

as law, medicine, architecture, accounting, engineering, etc.

Some states’ laws allow for the formation of Series underneath a main or master LLC, which has separate

rights, powers, or duties, or has a separate purpose or investment objective.

Each LLC which has a Series should register each of its separate Series which do business in Kentucky

with the Kentucky Secretary of State’s Oce as an assumed name.

For Kentucky Department of Revenue purposes, each Series within an LLC must register for its own

separate Corporation Income Tax and/or Limited Liability Entity Tax Account, unless it has chosen a

disregarded status.

Apply for a FEIN online at www.irs.gov or contact the IRS at (800) 829-4933. Sole Proprietorships and Disregarded Entities that do not have employees or

le certain federal excise tax returns may not be required to hold a FEIN for federal purposes. However, all businesses applying for Kentucky tax accounts

are encouraged to obtain a FEIN. A FEIN helps distinguish a business from others with similar names, and for certain documents, may be an alternative to

using a personal Social Security Number.

7. Kentucky Commonwealth Business Identier (CBI)—If your business has already been assigned a CBI, enter that 10-digit number. This number is used

to uniquely identify your business for the Kentucky One Stop Portal across all state agencies that utilize the portal.

8. Secretary of State Information—Sole Proprietorships, Estates, HCSRs, Governments, Unincorporated Non-Prot Associations, Unincorporated Associations,

Qualied Joint Ventures, and Non-statutory Trusts are not required to register with the Kentucky Secretary of State. General Partnerships or Joint Ventures

who do not operate using a DBA or Assumed Name are not required to register with the Kentucky Secretary of State.

For all remaining entities, enter the Organization Number assigned to your entity by the Kentucky Secretary of State’s Oce. Enter your date of incorporation/

organization and list the state in which you incorporated/organized. If an out-of-state entity, list the date you qualied with the Kentucky Secretary of State’s

Oce to do business in Kentucky.

9. Primary Business Location—List the street address, city, state and ZIP Code for the location for which you are requesting registration. Do not list a P.O.

Box for a business location address. For out-of-state businesses that do not have a Kentucky location, use the principal location address in your home state.

If your location is in Kentucky, enter county name. If out-of-state, leave county blank. Enter the telephone number for the listed location; include the area

code.

10. Business Operations are Primarily—Check the box where your business is primarily operated.

11. Accounting Period—Check the box that corresponds to when your business or organization’s accounting period ends. If you choose the scal year ling

box, enter the month and day when your year ends. If you choose the 52/53 week calendar year box, enter the month and day of the week your year ends.

If you choose the 52/53 week scal year box, enter the month and day of the week your year ends.

Note: Most businesses operate under a calendar year basis (year end December 31).

12. Accounting Method—Check the box corresponding to the accounting method your company uses.

Cash Basis—The business elects to report receipts in the accounting period that payment is actually or constructively received from the customer, even

though the customer may take possession of the product before actually paying for it.

Accrual Basis—The business elects to report receipts in the accounting period that the sale actually occurs, regardless of when the customer makes payment

for such purchases.

13. Business Structure—Check the box for the organizational structure type you have selected for your business. If “Other” selected, enter the structure type

on the blank provided.

A Public Benet Corporation is a special type of corporation created to perform a specic function for the

benet of the public.

Business Structure Basic Denition

Sole Proprietorship

One single person owning and/or operating a business, solely responsible for all debts and liabilities

incurred by the business.

General Partnership

Two or more individuals owning and/or operating a business. All partners jointly share prots and losses

and are individually responsible for debts incurred.

Joint Venture

A business entity that is generally short lived, frequently common to construction related activities,

where two or more individuals or businesses come together temporarily to participate in a prot making

activity. Usually, each partner specializes in a specic eld of expertise or has resources not available

to the other partner(s).

Estate

The total property, real and personal, that was owned by an individual, now deceased, before distribution

through a trust or will.

Government

City, county, state, and federal agencies.

Unincorporated Non-Prot

Association

An unincorporated informal group of members who come together to perform some social good conducted

for nonprot purposes. Per KRS 273A.005(6), “Nonprot purposes” means any one (1) or more of

the following purposes: charitable, benevolent eleemosynary, educational, civic, patriotic, political,

governmental, religious, social, recreational, fraternal, literary, cultural, athletic, scientic, agricultural,

horticultural, animal husbandry, and professional commercial, industrial, or trade association, but shall

not include labor unions, cooperative organizations, and organizations subject to any of the provisions

of the insurance laws or banking laws of this state which may not be organized under this chapter.

Trust (Non-statutory)

Business Trust

Statutory Trust

Series of a Statutory Trust

A legal entity that acts as duciary, agent or trustee on behalf of a person or business entity for the purpose

of administration, management and the eventual transfer of assets to a benecial party.

A Statutory Trust must register as such with the Kentucky Secretary of State’s Oce.

A Series of a Statutory Trust is a Series established by a Statutory Trust, which has separate rights, powers,

or duties, or has a separate purpose or investment objective. Each Statutory Trust should register each of

its separate Series with the Kentucky Secretary of State’s Oce as an assumed name. (KRS 386A.4-010)

For Kentucky purposes, Statutory Trusts and Series of Statutory Trusts are subject to the Limited Liability

Entity Tax.

For Kentucky Department of Revenue purposes, each Series within a Statutory Trust must register for its

own separate Limited Liability Entity Tax Account, unless it has chosen a disregarded status.

Limited Partnership (LP)

Limited Liability Partnership (LLP)

Limited Liability Limited Partnership

(LLLP)

Series of a Partnership

A partnership formed by two or more persons having one or more general partners and one or more

limited partners. The limited partner(s) have restricted liability for the business debts, while the general

partner(s) are fully liable. Limited liability will only be recognized for partnerships registered as a limited

partnership through a state’s Secretary of State’s Oce.

Some states’ laws allow for the formation of Series underneath the main or master Partnership, which

has separate rights, powers, or duties, or has a separate purpose or investment objective.

Each Partnership which has a Series should register each of its separate Series which do business in

Kentucky with the Kentucky Secretary of State’s Oce as an assumed name.

For Kentucky Department of Revenue purposes, each Series within a Partnership must register for its

own separate Limited Liability Entity Tax Account, unless it has chosen a disregarded status.

10A100(P)(11-23) Page 5

Association

An association is an unincorporated group joined together for a common purpose. However, associations

may be treated as corporations for Kentucky tax purposes.

Cooperative Corporation

Limited Cooperative Association

A group of individuals known as patrons who have supplied their own capital at their own risk, who

democratically direct and manage the enterprise, and who themselves receive the fruits of their

cooperative endeavors, through the allocation of the excess among themselves. In general, Cooperatives

are treated as corporations for Kentucky tax purposes.

Limited C ooperative Assoc iations must register as such with the Kentuc ky Secretar y of State’s O ce. This

business structure allows for investor members in addition to patron members. For Kentucky purposes,

Limited Cooperative Associations are also subject to the Limited Liability Entity Tax.

Business Structure Basic Denition

Qualied Joint Venture

A business jointly owned and operated by a married couple who are electing to have the business not

treated as a general partnership for federal tax purposes. Spouses electing qualied joint venture status

are treated as sole proprietors for federal tax purposes.

Other

Any ownership not elsewhere classied.

14. How will You be Taxed for Federal Purposes? Indicate how this business will be treated for federal purposes. If “Single Member Disregarded Entity, Other”

is selected, list what type of entity the single member is and how it is taxed.

10A100(P)(11-23) Page 6

15-16.

Ownership Disclosure—Responsible Parties—Enter the full legal name, Social Security Number (required if responsible party is an individual), FEIN

(if responsible party is another business), driver’s license number, driver’s license state of issuance, residence address, city, state, ZIP Code, telephone

number, county (if in Kentucky), business title and the date for when the title became eective for the information that corresponds to your business structure.

Note: Social Security Numbers for responsible parties are required (KRS 131.180(3)). Also, you are required to provide your Social Security Number

on tax forms per Section 405, Title 42, of the United States Code. This information will be used to establish your identity for tax purposes.

If your Business Structure is... Then the required Ownership/Responsible Party disclosure is...

Sole Proprietorship

n Prot Limited Liability Company (LLC) for Federal Purposes Taxed as

an Individual Sole Proprietorship

n Professional Limited Liability Company (PLLC) for Federal Purposes

Taxed as an Individual Sole Proprietorship

n Non-Prot Limited Liability Company (LLC) for Federal Purposes

Taxed as an Individual Sole Proprietorship

Enter owner’s individual information, including Social Security Number, in

question 15.

Do not use name abbreviations or nicknames.

Prot Limited Liability Company (LLC) for Federal Purposes Taxed as

a Single Member Disregarded Entity

n Professional Limited Liability Company (PLLC) for Federal Purposes

Taxed as a Single Member Disregarded Entity

n Non-Prot Limited Liability Company (LLC) for Federal Purposes

Taxed as a Single Member Disregarded Entity

Enter the single member’s company information, including FEIN, in question

15.

If the LLC has managers, their full individual information can be entered in

question 16. Attach a separate sheet for more LLC managers.

Qualied Joint Venture

Enter the information for the married couple, including Social Security

Numbers, in question 15 and 16.

Do not use name abbreviations or nicknames.

Unincorporated Non-Prot Association

Enter the members’/managers’ information in questions 15 and 16. If

members/managers are individuals, provide their Social Security Numbers.

If members/managers are other businesses, provide their FEINs.

If more than two members/managers, attach a separate sheet.

Prot Corporation

n Professional Service Corporation (PSC)

n Public Benet Corporation

n Association

n Cooperative Corporation

n Limited Cooperative Association

n Non-Prot Corporation

n Government

Enter the officers’ information, including Social Security Numbers in

questions 15 and 16. If more than two ocers, attach a separate sheet.

Note: Information for the President is required. The information for an Ocer

must be for an individual and not another business.

Statutory Trust

n Series of a Statutory Trust

n Business Trust

n Trust (non-statutory)

Enter the trustee information in questions 15 and 16. If trustees are

individuals, provide their Social Security Numbers. If trustees are other

businesses, provide their FEINs. If more than two trustees, attach a

separate sheet.

For a Series of a Statutory Trust, also provide the information for the master

Statutory Trust under which it was formed, including the FEIN for the master

Statutory Trust.

Home Care Service Recipient (HCSR)

A disabled or elderly individual participating in an in-home domestic services program administered by

a state or local agency where all or part of the services received are paid for with funds supplied by the

federal, state, or local government.

A Federal Identication Number (FEIN) is issued in the name of the disabled or elderly individual (Service

Recipient) as the employer. The Service Recipient or their family designates an agent to report, le, and

pay employment taxes on the Service Recipient’s behalf.

10A100(P)(11-23) Page 7

If your Business Structure is... Then the required Ownership/Responsible Party disclosure is...

Estate

Enter the information for the estate administrator, including Social Security

Number, in question 15.

Home Care Service Recipient (HCSR)

Enter the information, including FEIN, for the agent that has been designated

to report, le, and pay employment taxes on the Service Recipient’s behalf

in question 15. The business title for the agent should be listed as “HCSR

Agent”.

HCSR Agents are not liable for debts of the HCSR business and are

processing agents only.

17. Person to contact about this application— Enter the name, title, daytime telephone number, extension, and e-mail address for the person to contact with

questions about this application.

Enter the information for the master Partnership or master Limited Liability

Company, including FEIN, in question 15.

If the Series of the LLC has managers, their full individual information can

be entered in question 16. Attach a separate sheet for more LLC managers

of the Series.

Series of a Partnership

n Series of a Limited Liability Company

SECTION C—TELL US ABOUT YOUR BUSINESS OR ORGANIZATION—Answer questions 18 through 58 to determine accounts for which your business

or organization is required to apply.

18a. Business Activity Description—Give a description of the nature of your Kentucky business activity, including a description of any services provided.

18b. Products Sold in Kentucky—List any products sold in Kentucky.

18c. Current list of NAICS codes can be found at https://www.census.gov/naics

19. An employee is anyone to whom you pay wages, including part-time help and family members (KRS 141.010, 103 KAR 18:010 and 103 KAR 18:070).

Kentucky corporate ocers who receive compensation, other than dividends, are legally considered employees for withholding purposes (KRS 141.010).

20. Kentucky withholding is not required from wages of Kentucky residents that work entirely outside the state, but your business may choose to voluntarily

21. Kentucky withholding is not required from payments of pensions/retirements, but your business may choose to voluntarily register to withhold.

22. If your business is required to withhold federal tax on gaming payouts made to Kentucky residents, then it will also be required to withhold Kentucky tax.

The business is required to obtain an Employer’s Withholding Tax Account for reporting and paying the Kentucky withholding.

23. All businesses or organizations making regular and continuous sales of Tangible Property or Digital Property within Kentucky, including those via Internet

and at ea markets or antique malls, are required to register for a Sales and Use Tax Account.

Tangible Personal Property (KRS 139.010(46)) “means personal property which may be seen, weighed, measured, felt or touched, or which is in any

way or manner perceptible to the senses, and includes natural, articial, and mixed gas, electricity, water, steam, and prewritten computer software.”

Digital Property (KRS 139.010(11)) “means any of the following which is transferred electronically: digital audio works, digital books, nished artwork,

digital photographs, periodicals, newspapers, magazines, video greeting cards, audio greeting cards, video games, electronic games, or any digital code

related to this property. Digital Property does not include audio-visual works or satellite radio programming.”

Joint Venture

n General Partnership

n Limited Partnership (LP)

n Limited Liability Partnership (LLP)

n Limited Liability Limited Partnership (LLLP)

n Limited Liability Company (LLC) for Federal Purposes Taxed as Other

Than Disregarded

n Professional Limited Liability Company (PLLC) for Federal Purposes

Taxed as Other Than Disregarded

n Non-Prot Limited Liability Company (LLC) for Federal Purposes

Taxed as Other Than Disregarded

Enter the partners’/members’ information in questions 15 and 16. If partners/

members are individuals, provide their Social Security Numbers. If partners/

members are other businesses, provide their FEINs.

If more than two partners/members, attach a separate sheet.

Note:

For any entity taxed as a partnership at least two partners/members

must be listed.

10A100(P)(11-23) Page 8

24. A repairer or reconditioner of tangible property is a retailer of parts and materials furnished in connection with repair work and as such must collect Sales

and Use Tax (103 KAR 27:150).

25. Charges, including labor charges, for producing, fabricating, processing, printing, or imprinting tangible property are subject to Sales and Use Tax (103 KAR

27:130 and 103 KAR 28:030).

26. Beginning July 1, 2018, the amount charged for labor or services rendered in installing or applying the tangible personal property, digital property, or service

sold is subject to Sales and Use Tax (KRS 139.010(17)(a)(6)).

27a. Beginning July 1, 2018, the collection of Sales and Use Tax is required on the following services (KRS 139.200(2)(g-o)).

Landscaping services, including but not limited to:

n Lawn care and maintenance services

n Tree trimming, pruning or removal services

n Landscape design and installation services

n Landscape care and maintenance services

n Snow plowing or removal services

Janitorial services, including but not limited to:

n Residential and commercial cleaning services

n Carpet, upholstery, and window cleaning services

Small animal veterinary services, excluding veterinary services for equine,

cattle, poultry, swine, sheep, goats, llamas, alpacas, ratite birds, bualo,

and cervids.

Pet care services, including but not limited to:

Grooming and boarding services

n Pet sitting services

n Pet obedience or training services

Industrial laundry services, including but not limited to:

n Industrial uniform supply services

n Protective apparel supply services

n Industrial mat and rug supply services

Linen supply services, including but not limited to:

n Table and bed linen supply services

n Non-industrial uniform supply services

Indoor skin tanning services, including but not limited to:

n Tanning booth or tanning bed services

n Spray tanning services

Non-medical diet and weight reducing services

Non-coin operated laundry and dry cleaning services

Photography and photo nishing services

n Taking, developing, or printing of an original photograph

n Image editing, composite image creation, formatting, watermarking

printing, and delivery of an original photograph in the form of tangible

personal property, digital property, or other media

n Excludes services necessary for medical or dental health

Private mailroom services

n Presorting mail and packages by postal code

n Address bar coding

n Tracking

n Delivery to postal services

n Private mailbox rentals

Public opinion and research polling services

Telemarketing services

n Services provided via telephone, facsimile, electronic mail, text

messages, or other modes of communications to another person, which

are unsolicited by that person, for the purposes of promoting products

or services, taking orders, providing information or assistance regarding

the products or services, or soliciting contributions

Rental of space for meetings, conventions, short-term business uses,

entertainment events, weddings, banquets, parties, and other short-term

social events

Leisure, recreational and athletic instructional services

Social event planning and coordination services

27b. Beginning January 1, 2023, the collection of Sales and Use Tax is required on the following services (KRS 139.200 (2) (q) – (ax)).

28. Beginning July 1, 2018, the sale of an extended warranty on tangible or digital property is subject to Sales and Use Tax (KRS 139.200((2)(p)).

Beginning July 1, 2019, extended warranty services do not include the sale of a service contract agreement for tangible personal property to be used by a

small telephone utility or a Tier III CMRS provider (KRS 139.010(15)(b)).

Beginning January 1, 2023, the denition for extended warranty services includes extended warranty contracts for real property and all extended warranty

contracts for tangible personal property and digital property regardless of whether the property itself is taxable or exempt.

29. Rental of tangible property or digital property is a taxable activity. Additionally, if you have formed a separate business to hold title to equipment, machinery, or

other tangible property or digital property for lease back to another business you own, you will be required to charge Sales and Use Tax on those transactions

(103 KAR 28:051).

30. Beginning July 1, 2018, admissions paid for the right of entrance to an entertainment or amusement event or venue are subject to Sales and Use Tax, except

admission to racetracks taxed under KRS 138.480, admission to historical sites exempt under KRS 139.482, admission taxed under KRS 229.031, unarmed

combat show not licensed under KRS 229.061. Initiation fees, monthly fees, and membership fees paid for the use of a facility or participating in an event or

activity, regardless of whether the fee is paid per use or in any other form, are subject to Sales and Use Tax (KRS139.010 (1)).

Beginning March 26, 2019, admissions charged by nonprot educational, charitable, religious institutions, non-prot civic, government or other non-prot

organizations are exempt from Sales and Use Tax (KRS 139.200(2)(c)).

Beginning July 1, 2019, admissions paid to enter or participate in a shing tournament, and any fee paid for the use of a boat ramp for the purposes of allowing

boats to be launched into or hauled out from water are exempt from Sales and Use Tax (KRS 139.010(1)(b)).

Beginning August 1, 2020, all golf course admissions are subject to sales tax whether sold by a for-prot or a non-prot entity, unless for fundraising event

by a non-prot entity (KRS 139.498).

Beginning July 14, 2022, admissions to enter grounds or enclosure of any track licensed under KRS Chapter 230 at which live horse racing or historical horse

racing is being conducted under the jurisdiction of the Kentucky Horse Commission are exempt from Sales and Use Tax (KRS 139.200(c)(1)).

Beginning January 1, 2023, admissions sales to historical sites under KRS 139.482 are no longer exempt from Sales and Use Tax.

10A100(P)(11-23) Page 9

Lobbying services

Specialized design services, including

The design of clothing, costumes, fashion, furs, jewelry, shoes, textiles,

and lighting

Parking services

n Valet services

n The use of parking lots and parking structures

n Excludes any parking services at an educational institution

Cosmetic surgery services

n Modications to all areas of the head, neck, and body to enhance

appearance through surgical and medical techniques

n Excludes surgery services that are medically necessary to reconstruct

or correct dysfunctional areas of the face and body due to birth disorders,

trauma, burns, or disease.

Lapidary services, including

Cutting, polishing, and engraving precious stones

Body modication services, including

n Tattooing, piercing, scarication, branding, tongue splitting, transdermal

and subdermal implants, ear pointing, teeth pointing, and any other

modications that are not necessary for medical or dental health

Prewritten computer software access services

n Services for the right of access to prewritten computer software where

the object of the transaction is to use the prewritten computer software

while possession of the prewritten computer software is maintained by the

seller or a third party, wherever located, regardless of whether the charge

of the access or use is on a per use, per user, per license, subscription,

or some other basis

Recreational camp tuition and fees

Executive employee recruitment services

Residential and non-residential security system monitory services

Household moving services

Website design and development services

Process Server Services

Road and travel services provided by automobile services

Web site hosting services

Repossession of tangible personal property services

Labor to repair or alter apparel, footwear, watches, or jewelry

Personal tness training services

Private investigation services

Personal Background check services

Massage services, unless medically necessary

Laboratory testing services, except for medical, educational, veterinary

reasons, or if required by a federal, state, or local statute, regulation, court

order, or other government-related requirement.

Labor and services to repair or maintain commercial refrigeration services

Bodyguard services

Interior decorating and design services

Condominium time-share exchange services

10A100(P)(11-23) Page 10

31. Beginning July 1, 2018, a remote retailer selling tangible personal property or digital property delivered or transferred electronically to a purchaser in this

state if: the remote retailer sold tangible personal property or digital property that was delivered or transferred electronically to a purchaser in this state in

two hundred (200) or more separate transactions in the previous calendar year or the current calendar year; or the remote retailer’s gross receipts derived

from the sale of tangible personal property or digital property delivered or transferred electronically to a purchaser in this state in the previous calendar year

or current calendar year exceeds one hundred thousand dollars ($100,000) (KRS 139.340(g)).

32. You as the agent are required to hold a Kentucky Sales and Use Tax Permit, if the manufacturer for whom you sell does not hold a valid Kentucky Sales and

Use Tax Permit (KRS 139.010(40)(b)).

33. “Marketplace” means any physical or electronic means through which one or more retailers may advertise and sell tangible personal property, digital

property, or services, or lease tangible personal property or digital property. Examples of a marketplace are: a catalog; an Internet website; or a television

or radio broadcast, regardless of whether the tangible personal property, digital property, or retailer is physically present in the Commonwealth of Kentucky.

KRS 139.010(24))

33a. ”Marketplace provider” means a person, including any aliate of the person, that facilitates a retail sale directly or indirectly (KRS 139.010(25)).

33b. ”Marketplace retailer” means a seller that makes retail sales through any marketplace owned, operated, or controlled by a marketplace provider.

(KRS 139.010(26))

33c. Businesses that operate an online marketplace and facilitate sales by a third party marketplace retailer must collect sales and use tax for the sales

transactions facilitated through the online marketplace in addition to the sales made on behalf of their own businesses. (KRS 139.450(2)) A business

facilitating online marketplace sales by a third party marketplace retailer may choose whether to register for one sales tax account for reporting both its

own sales and the sales it facilitates, OR to register for two separate sales tax accounts, one for reporting its own sales and the other for reporting the

sales it facilitates for others.

34. A contract miner or a fee processor is an independent party to whom a manufacturer/industrial processor pays a fee to perform a step or series of steps in the

manufacturing or mining process. Contract miners and fee processors may issue resale certicates for materials, supplies, and industrial tools used directly

in the manufacturing/mining process provided the tools have a useful life of less than one year. Resale certicates cannot be issued for repair, replacement

or spare parts.

35. Any vendor who contracts to sell, install, or provide services to the Commonwealth of Kentucky or one of its agencies, is required to register for Kentucky

Sales and Use Tax per KRS 45A.067, and collect and remit the Sales and Use Tax imposed by KRS Chapter 139. In order to complete the bidding process

with the Commonwealth or one of its agencies, an original application applying for a Sales and Use Tax Account or a copy of your Sales and Use Tax

Permit must be submitted with the bid packet. Failure to obtain the required account and remain in compliance with KRS Chapter 139 during the life of

your contract may result in termination of your contract with the Commonwealth (200 KAR 5:390).

36. If you make sales into Kentucky and are an aliate of a company who contracts to sell, install, or provide services to the Commonwealth, you are required

to register for Kentucky Sales and Use Tax per KRS 45A.067 and collect and remit the Sales and Use Tax imposed by KRS Chapter 139.

37. The rental of any lodgings, campsites, or accommodations furnished by any campground or recreational vehicle park are subject to Sales and Use Tax

(KRS 139.200(2)(a)) and Transient Room Tax (KRS 142.400). The tax shall not apply to lodgings, campsites, or accommodations supplied for a continuous

period of thirty days or more to a person.

38. All receipts collected from the Sales and Use Tax on the fees paid for breeding a stallion to a mare will be deposited into a fund, which will be administered

by the Kentucky Horse Racing Commission to enhance the equine breeding industry in the state. Taxpayers who report sales tax on equine breeding fees

are required to complete the Kentucky Sales and Use Tax Equine Breeders Supplementary Schedule (Form 51A132) with their Sales and Use Tax returns

per 103 KAR 27:240.

Note: Copies of this supplemental schedule are available at www.revenue.ky.gov or for more information contact the Division of Sales and Use Tax,

Department of Revenue, P.O. Box 181, Station 67, Frankfort, Kentucky 40602, or call (502) 564-5170.

39. All receipts collected from the Sales and Use Tax for aviation jet fuel will be deposited into the Kentucky Aviation Economic Development Fund which is

administered by the Kentucky Transportation Cabinet to enhance the aviation industry in the state. Taxpayers who report sales tax on aviation jet fuel sales

are required to complete the Kentucky Sales and Use Tax Monthly Aviation Fuel Dealer Supplementary Schedule (Form 51A131) with their Sales and Use

Tax returns.

Note: Copies of this supplemental schedule are available at www.revenue.ky.gov or for more information, contact the Division of Sales and Use Tax,

Department of Revenue, P.O. Box 181, Station 67, Frankfort, Kentucky 40602, or call (502) 564-5170.

40a. Kentucky motor vehicle dealers who make sales of vehicles to residents of Arizona, California, Florida, Indiana, Massachusetts, Michigan, South Carolina,

or Washington must collect Kentucky Sales and Use Tax on the selling price of the vehicle, less the trade-in allowance for like-kind exchanges. These

receipts are to be reported and paid with the ling of the dealer’s regular Sales and Use Tax return. Taxpayers who report such sales are required to

complete and le a Kentucky Sales Tax Motor Vehicle Sales Supplementary Schedule (Form 51A135) which provides a breakdown for the portion of total

sales that relates specically to sales of motor vehicles to those nonresident customers. The supplementary schedule is due on the same date as the

Sales and Use Tax return and may be led online at www.revenue.ky.gov .

Note: For more information contact the Division of Sales and Use Tax, Department of Revenue, P.O. Box 181, Station 67, Frankfort, Kentucky 40602, or call

(502) 564-5170.

40b. Kentucky dealers who make sales of recreational vehicles to residents of Arizona, California, Florida, Hawaii, Massachusetts, Michigan, North Carolina,

South Carolina, and Wisconsin must collect Kentucky Sales and Use Tax on the selling price of the recreational vehicle, less the trade-in allowance for like-

kind exchanges. “Recreational vehicle” is dened as any motor home, travel trailer, fth-wheel trailer, pull-behind camper, or pop-up camping trailer which

contains living quarters and is required to be licensed for use on the public highways (KRS 138.450).

41. Temporary rental of rooms, lodgings, campsites, or other accommodations by any hotel, motel, inn, campground, recreational vehicle park, tourist camp, or

other place regularly providing accommodations to transients are subject to Sales and Use Tax (KRS 139.200) and Transient Room Tax. The Transient Room

Tax adds a one (1) percent tax of the rent in addition to the current 6 percent sales tax (KRS 142.400). “Temporary” does not apply to rooms, lodgings, or

accommodations supplied for a continuous period of thirty days or more to a person.

Note: For more information contact the Excise Tax Section, Department of Revenue, P.O. Box 1303, Station 62, Frankfort, Kentucky 40602-1303, or call

(502) 564-6823.

10A100(P)(11-23) Page 11

42. Retail businesses which sell new tires for motor vehicles and semi-trailers are subject to Sales and Use Tax and the Motor Vehicle Tire Fee. Eective July 1,

2018, the fee imposed for each new motor vehicle tire sold in Kentucky is subject to the Kentucky sales tax. Eective July 1, 2020, a fee is imposed on new

trailer and semitrailer tires sold in Kentucky is subject to the Kentucky sales tax. (KRS 224.50-868(2)(a)(2) and (2)(a)(3))

Note: For more information contact the Financial Tax Section, Department of Revenue, P.O. Box 1303, Station 61, Frankfort, Kentucky 40602-1303, or

call (502) 564-4810.

43. Per KRS 65.7621-.7643 and KRS 142.110, businesses required to collect the Commercial Mobile Radio Service (CMRS) Prepaid Service Charge from

consumers pursuant to KRS 65.7634 are required to register with the Department of Revenue and remit the CMRS prepaid service charge electronically.

(KRS 142.115; 103 KAR 1:160 sec. 4(2))

44. Businesses who perform manufacturing, industrial processing, mining, or rening who document that their cost of energy or energy-producing fuels exceeds

3 percent of the cost of production may submit an application for Energy Direct Pay (EDP) Authorization. Those businesses that choose to do so may also

apply for the EDP Utility Gross Receipts License Tax (UGRLT) exemption. A Sales and Use Tax Account number must be obtained by all businesses who

hold an EDP Authorization. Those businesses that are approved for the UGRLT EDP exemption are required to obtain a UGRLT account number to le and

remit the UGRLT monthly returns electronically. You must attach a copy of your ocial UGRLT Exemption Authorization to this application.

45. Sales of water utilities, gas utilities, electricity, or sewer services to nonresidential customers are subject to Sales and Use Tax. Communication services are

also subject to Sales and Use Tax.

*While the sale of cable, satellite broadcast, Internet protocol television services, and video streaming services are not subject to Sales and Use Tax,

cable services, satellite broadcast services, Internet protocol television services, video streaming services, and communication services are subject to

Telecommunications Tax (KRS Chapter 136).

Also, cable services, Internet protocol television services, video streaming services, communication services, and the other utility services listed above are

subject to Utility Gross Receipts License Tax (KRS 160.614).

Providers of cable services or Internet protocol services should check Box F. Providers of video streaming services should check Box G. Providers of

satellite services should check Box H.

Communication services (KRS 136.602 and KRS 160.6131) include, but are not limited to: local and long distance telephone services; telegraph and

teletypewriter services; pre-paid calling services and postpaid calling services; private communications services involving a direct channel specically

dedicated to a customer’s use between specic points; channel services involving a path of communications between two (2) or more points; data transport

services involving the movement of encoded information between points by means of any electronic, radio, or other medium or method; caller ID services,

ring tones, voice mail, and other electronic messaging services; mobile wireless telecommunications service; and, xed wireless service as dened in

KRS 139.195; and voice over Internet protocol (VOIP).

Note: For more information about Telecommunications Tax, contact the Division of Sales and Use Tax, Department of Revenue, P.O. Box 181, Station 66,

Frankfort, Kentucky 40602, or call (502) 564-5170 (Option 2). For more information about Utility Gross Receipts License Tax, contact the Financial Tax Section,

Department of Revenue, P. O. Box 1303, Station 61, Frankfort, Kentucky 40602-1303, or call (502) 564-4810 (KRS 136.600-136.660 and KRS 160.613).

46. If you make a purchases of any named utility type in question 45 B through G, mark Yes and list the provider’s name and utility type in 46b. Otherwise, check

No.

47. Per KRS 139.330, a 6 percent Use Tax is due if you make out-of-state purchases of tangible personal property, digital property, or taxable services under

KRS 139.200(2)(p) - (ax) for storage, use, or other consumption in Kentucky and did not pay at least 6 percent state Sales Tax to the seller at the time of

purchase. For example, if you order from catalogs, make purchases through the internet, or shop outside Kentucky for items such as construction supplies,

construction equipment, oce furniture, computer equipment, medical equipment, software, oce supplies, books, or subscribe to magazines or professional

journals, you will owe Use Tax to Kentucky. This list is not all-inclusive. It is important to remember that Use Tax applies only to items purchased outside

Kentucky, including another country, which would have been taxed if purchased in Kentucky.

Note: If your business did make or will make a one-time only out-of-state purchase or will not regularly make these types of purchases, check this question

No. Do not complete the section to apply for a Consumer’s Use Tax Account. You will need to complete Form 51A113(O), Consumer’s Use Tax Return, to

report and pay the applicable Use Tax. To obtain Form 51A113(O), call the Division of Sales and Use Tax at (502) 564-5170 or download the form from our

website at www.revenue.ky.gov .

48. For assistance, contact the Kentucky Secretary of State’s Oce at (502) 564-3490 or visit them online at www.sos.ky.gov .

49. A commercial domicile is the principal place from which the trade or business of the corporation is managed (103 KAR 16:240).

50. Owning or leasing property in this state means owning or leasing real or tangible property in Kentucky, including: maintaining an oce or other place of

business in Kentucky; maintaining in Kentucky an inventory of merchandise or material for sale, distribution or manufacture, or consigned goods, regardless

of whether kept on the taxpayer’s premises, in a public or rented warehouse, or otherwise; or owning computer software used in the business of a third party

within Kentucky (103 KAR 16:240). See denition in instruction 23 for tangible property.

51. Corporations and Limited Liability Entities with individuals performing services in Kentucky are subject to Kentucky Corporation Income Tax and/or Limited

Liability Entity Tax. The business is considered as performing services in Kentucky whether the services are provided directly by the business or indirectly

by directing activity performed by a third party (103 KAR 16:240). Services do not include the mere solicitation of the sale of tangible personal property.

52. A Pass-Through Entity is any partnership, joint venture, S corporation, limited cooperative association, statutory trust, series of a statutory trust, limited

partnership (LP), limited liability partnership (LLP), limited liability limited partnership (LLLP), series of a partnership, limited liability company (LLC),

professional limited liability company (PLLC), series of a limited liability company, or similar entity recognized by the laws of this state that is not taxed at

the entity level, but instead passes to each partner, member, shareholder, or owner their proportionate share of income, deductions, gains, losses, credits,

and any other similar attributes. You are required to register for a Kentucky Corporation Income Tax Account and/or a Limited Liability Entity Tax Account

to report the income generated from a pass-through entity (KRS 141.010) or otherwise derived from or attributable to sources in Kentucky.

53. Directing activities at Kentucky customers for the purpose of selling goods is taxable in Kentucky. This includes selling or soliciting orders for real property,

intangible personal property, tangible property, or delivering merchandise inventory on consignment to its Kentucky distributors or dealers. Directing activities

at Kentucky customers for the purpose of selling services, in addition to unprotected solicitation activities, is taxable in Kentucky (103 KAR 16:240).

54. Intangible property is subject to Kentucky Corporation Income Tax and/or Limited Liability Entity Tax (103 KAR 16:240).

10A100(P)(11-23) Page 12

For Corporation Income Tax, nothing in questions 48 through 54 shall be interpreted in a manner that goes beyond the limitations imposed and

protections provided by the United States Constitution or Public Law No. 86-272. Public Law No. 86-272 does not apply to the Limited Liability Entity Tax.

55. See instruction 52 for an explanation of pass-through entities.

56a-56b. If your pass-through entity has nonresident individual/corporate partner(s), individual/corporate member(s), or individual shareholder(s) that receive

Kentucky distributive share income from your pass-through entity, check Yes to A and/or B.

Note: For tax years beginning on or after January 1, 2007, every pass-through entity required to le a return under KRS 141.206(1) shall withhold

Kentucky income tax at the maximum rate provided in KRS 141.020 or 141.040 on the distributive share income, whether distributed or undistributed,

of each: (i) nonresident individual (includes a nonresident estate or trust) partner, member or shareholder; and (ii) corporate partner or member that is

doing business in Kentucky only through its ownership interest in a pass-through entity. The withholding shall be led with the Department of Revenue on

Form 740NP-WH, Kentucky Nonresident Income Tax Withholding on Distributive Share Income Report and Composite Income Tax Return, on or before

the 15th day of the fourth month after the close of the pass-through entity’s taxable year, and shall include: (i) Form PTE-WH, Kentucky Nonresident

Income Tax Withholding on Distributive Share Income, for each nonresident individual partner, member, or shareholder and each corporate partner

or member included in Form 740NP-WH; and (ii) remittance of the income tax due. A copy of Form PTE-WH shall be provided to each nonresident

individual partner, member, or shareholder and each corporate partner or member included in Form 740NP-WH.

57 - 58. Every person engaged in severing and/or processing coal, including refuse coal, must le an application to obtain a Certicate of Registration and Coal

Seller/Purchaser Certicate ID Number with the Kentucky Department of Revenue before severing and/or processing coal in Kentucky (KRS 143.030).

Processing includes cleaning, breaking, sizing, dust allaying, treating to prevent freezing, or loading or unloading for any purpose. This is limited to

persons who own or have an economic interest in the coal and does not include a contract miner. Persons who only receive an arm’s length

royalty are not considered as having an economic interest and are not required to register.

Note: Persons required to obtain a Certicate of Registration for Coal Severance and Processing Tax must also apply for a Sales and Use Tax Permit

in Section E of this application.

59. Coal brokers, while not subject to coal tax, will be issued a Coal Seller/Purchaser Certicate ID Number that must be used in all sales and purchases

of coal on Form 55A004.

SECTION D—EMPLOYER’S WITHHOLDING TAX ACCOUNT

Note: Businesses must electronically le their withholding tax returns. For legal reference, see 103 KAR 18:150 Sec 2(6) & (7).

60. Existing Tax Account—If an Employer’s Withholding Tax Account number has already been assigned to this business, check Yes and list the account

number in B.

If per Section A of the application your business was required to re-register for new accounts, or an Employer’s Withholding Tax Account was never assigned

to your business, check No and leave B blank.

61. Number of Kentucky Employees—Enter the total number of full-time and part-time persons expected to be employed yearly in Kentucky; including Kentucky

residents that perform work outside the state of Kentucky. For Kentucky businesses, who are for federal purposes electing taxation as corporations, include

ocers who will be receiving compensation.

62. Date Wages or Pensions First Paid—Enter the date wages or pensions were or will be paid to employees.

63. Estimated Total Annual Tax Withheld—Check the estimated dollar amount of withholding you will be remitting to the Department of Revenue on an annual

basis.

64. Common Paymaster or Common Pay Agent—If your business will report the withholding for your employees through an account issued to a Common

Paymaster or Common Pay Agent instead of an account issued to your business, check Yes and attach a listing of the information for the Common Paymaster

or Common Pay Agent you are contracted with to this application.

Common Paymaster—Two or more related corporations employing the same individual at the same time and paying this individual through one of the

corporations which is designated as the “common paymaster”. The common paymaster is responsible for ling information and tax returns and issuing Forms

K-2 with respect to wages.

Common Pay Agent—An independent third party your business has contracted with for ling information and tax returns and issuing Forms K-2 on behalf of

your business and for which you have led federal Form 2678, Employer/Payer Appointment of Agent, to appoint them as your agent.

65. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate

box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and

list which account address you wish to use.

If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, ZIP Code, county (if in Kentucky), and the telephone

number for this address in this section. You may include a P. O. Box here.

10A100(P)(11-23) Page 13

SECTION E—SALES AND USE TAX ACCOUNT (Including Transient Room Tax Account, Motor Vehicle Tire Fee Account, and Commercial Mobile Radio

Service (CMRS) Prepaid Service Charge Account)

Note: Businesses must electronically le and pay their Sales and Use, Transient Room, Motor Vehicle Tire Fee, and Commercial Mobile Radio Service tax returns.

For legal reference, see 103 KAR 1:160.

66. Existing Tax Account—

If a Sales and Use Tax Account number has already been assigned to this business, check Yes and list the account number in B.

If per Section A of the application your business was required to re-register for new accounts, or a Sales and Use Tax Account was never assigned to your

business, check No and leave B blank.

67. Date Sales Began or Will Begin—Give the date that sales, services, repairs, rentals, leases, lodgings, or admissions began or will begin in Kentucky.

68. Estimated Gross Monthly Sales Tax Collected—Check estimated amount of monthly sales tax collected in Kentucky.

69. Additional Kentucky Locations—If you have additional business locations in Kentucky, check Yes. For each location, attach a listing of the information

found in question 69B.

70. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate

box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and

list which account address you wish to use.

If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone

number for this address in this section. You may include a P. O. Box here.

SECTION F—UTILITY GROSS RECEIPTS LICENSE TAX ACCOUNT

Note: Tax returns for Utility Gross Receipts License Tax are required to be led online. See the application for the website addresses to use to register for online

ling once your account has been assigned.

71. Existing Tax Account—If a Utility Gross Receipts License Tax Account number has already been assigned to this business, check Yes and list the account

number in B.

If per Section A of the application your business was required to re-register for new accounts, or a Utility Gross Receipts License Tax Account was never

assigned to your business, check No and leave B blank.

72. Date Sales or Purchases of Utilities Began or Will Begin—Give the date sales of communications, multichannel video programming services, and/or

direct broadcast satellite services, water utilities, natural, articial, or mixed gas, electricity, or sewer services began or will begin in Kentucky.

73. Telephone Number—List the telephone number for the business.

74. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate

box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and

list which account address you wish to use.

If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone

number for this address in this section. You may include a P. O. Box here.

SECTION G—TELECOMMUNICATIONS TAX ACCOUNT

Note: Tax returns for Telecommunications Tax are required to be led online. See the application for the website address to use to register for online ling once

your account has been assigned.

75. Existing Tax Account—If a Telecommunications Tax Account number has already been assigned to this business, check Yes and list the account number

in B.

If per Section A of the application your business was required to re-register for new accounts, or a Telecommunications Tax Account was never assigned to

your business, check No and leave B blank.

76. Tangible Personal Property—If your business has tangible personal property located in Kentucky, check Yes. See instruction 23 for a denition of tangible

property.

Note: If you answered Yes, you are required to centrally le an annual property tax return titled Revenue Form 61A500(P), Personal Property Tax Forms

and Instructions for Communications Service Providers & Multichannel Video Programming Service Providers. This return is due May 15 and is led with the

Oce of Property Valuation, Division of State Valuation, Public Service Branch, Station 32, 501 High Street, Frankfort, KY 40601. For more information call

(502) 564-8175.

77. Company Types—Select the appropriate company type for your business.

78. Date Sales of Communications Began or Will Begin—Give the date sales of communications, multichannel video programming services, and/or direct

broadcast satellite services began or will begin in Kentucky.

79. Telephone Number—List the telephone number for the business.

80. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate

box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and

list which account address you wish to use.

If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone

number for this address in this section. You may include a P. O. Box here.

10A100(P)(11-23) Page 14

SECTION H—CONSUMER’S USE TAX ACCOUNT

81.

Existing Tax Account—If a Consumer’s Use Tax Account number has already been assigned to this business, check Yes and list the account number in B.

If per Section A of the application, your business was required to re-register for new accounts, or a Consumer’s Use Tax Account was never assigned to your

business, check No and leave B blank.

82. Date Purchases Began or Will Begin—Give the date that purchases of tangible property, digital property, or taxable services under KRS 139.200(2)(p) -

(ax) began or will begin.

83. Send Mail Related to this Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate

box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and

list which account address you wish to use.

If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone

number for this address in this section. You may include a P. O. Box here.

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

Note: All corporations and all limited liability entities should be registered with the Kentucky Secretary of State’s Oce in order to conduct business within

Kentucky. You may contact their oce at (502) 564-3490, or visit their website at http://sos.ky.gov to determine your registration requirements.

84. Existing Tax Account—If a Corporation Income Tax and/or a Limited Liability Entity Tax Account number has already been assigned to this business, check

Yes and list the account number in B.

If per Section A of the application, your business was required to re-register for new accounts, or a Corporation Income Tax or a Limited Liability Entity Tax

Account was never assigned to your business, check No and leave B blank.

85. Entity Treated as a Division—If your entity is not separately taxed and is instead federally treated as a division of a parent company, check Yes and select

the division type in item B.

86. Mere Solicitation—If you are an out-of-state entity, check if your activity in Kentucky is mere solicitation of the sale of tangible property which is protected

under Public Law 86-272. Public Law 86-272 does not apply to the Limited Liability Entity Tax.

87. Date Activity Began for Out-of-State Entities—Enter the date that your business or organization began business activities in Kentucky or began receiving

pass-through income from Kentucky sources.

88. Exempt Organizations—Indicate whether your business or organization is exempt from Corporation Income Tax and/or Limited Liability Entity Tax by

Kentucky statute. If Yes, see Exemption Table 1 and enter the appropriate code that matches your exemption type in item B.

If you select “Political Organization” in B, indicate in item C whether your entity is required to le federal Form 1120-POL.

Note to corporations exempt from federal income taxation: Corporations which are exempt from federal income taxation under Section 501(c)(3) of the

Internal Revenue Code, must attach a copy of the determination of exemption letter issued by the IRS.

89. Send Mail Related to this Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate

box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and

list which account address you wish to use.

If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone

number for this address in this section. You may include a P. O. Box here.

10A100(P)(11-23) Page 15

EXEMPTION TYPE

EXEMPTION TABLE 1

CODE

Insurance company, including farmers or other mutual hail, cyclone, windstorm, or re insurance companies, insurers, and

reciprocal underwriters (does not include insurance agencies)

Corporation or other entity exempt under Section 501 of the Internal Revenue Code

Religious, educational, charitable, or like corporation not organized or conducted for pecuniary prot

Corporation whose only owned or leased property located in this state is located at the premises of a printer with which it has

contracted for printing, provided that: 1. The property consists of the nal printed product, or copy from which the printed product

is produced; and 2. The corporation has no individuals receiving compensation in this state as provided in KRS 141.120(8)(b)

Public service corporation subject to tax under KRS 136.120

Open-end registered investment company organized under the laws of this state and registered under the Investment Com-

pany Act of 1940

Any property or facility which has been certied as a uidized bed energy production facility as dened in KRS 211.390

An alcohol production facility as dened in KRS 247.910

Real estate investment trust (REIT) as dened in Section 856 of the Internal Revenue Code

Captive real estate investment trust (Captive REIT)

Regulated investment company (RIC) as dened in Section 851 of the Internal Revenue Code

Real estate mortgage investment conduit (REMIC) as dened in Section 860D of the Internal Revenue Code

Personal service corporation as dened in Section 269A(b)(1) of the Internal Revenue Code

Qualied investment partnership (QIP) as dened in KRS 141.206(14)

Cooperative described in Sections 521 and 1381 of the Internal Revenue Code (Select category below)

Farmers’ agricultural and other cooperatives organized or recognized under KRS Chapter 272

Advertising cooperatives

Purchasing cooperatives

Homeowner’s associations including those described in Section 528 of the Internal Revenue Code

Political organizations as dened in Section 527 of the Internal Revenue Code

Rural electric and rural telephone cooperatives

19A

19B

19C

19D

19E/F

19G

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

90. Existing Tax Account—If a Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account number has already been assigned

to this business, check Yes and list the account number in B.

If per Section A of the application your business was required to re-register for new accounts, or a Kentucky Nonresident Income Tax Withholding on Distributive

Share Income Tax Account was never assigned to your business, check No and leave B blank.

91. Date First Nonresident Corporation or Individual Became a Partner, Member, or Shareholder—Enter the date that your business or organization received

its rst Kentucky nonresident partner, member, or shareholder.

92. Exempt Organizations—Indicate whether your business or organization is exempt from Kentucky Nonresident Income Tax Withholding on Distributive Share

Income Tax by Kentucky statute. If Yes, see Exemption Table 2 below and enter the appropriate code that matches your exemption type in item B.

93. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate

box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and

list which account address you wish to use.

If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone

number for this address in this section. You may include a P. O. Box here.

10A100(P)(11-23) Page 16

EXEMPTION TYPE

EXEMPTION TABLE 2

CODE

Insurance company, including farmers or other mutual hail, cyclone, windstorm, or re insurance companies, insurers, and

reciprocal underwriters (does not include insurance agencies)

Corporation or other entity exempt under Section 501 of the Internal Revenue Code

Religious, educational, charitable, or like corporation not organized or conducted for pecuniary prot

Corporation whose only owned or leased property located in this state is located at the premises of a printer with which it has

contracted for printing, provided that: 1. The property consists of the nal printed product, or copy from which the printed product

is produced; and 2. The corporation has no individuals receiving compensation in this state as provided in KRS 141.120(8)(b)

Publicly Traded Partnership as dened in KRS 141.0401(6)(b)(14)

Qualied Investment Partnership (QIP) as dened in KRS 141.206(14)

Qualied Subchapter S-Corporation Subsidiary (QSUB)

SECTION K—COAL SEVERANCE/PROCESSING TAX AND/OR COAL SELLER/PURCHASER CERTIFICATE ID NUMBER

94. Existing Tax Account—If a Coal Severance/Processing Tax Account number and/or a Coal Seller/Purchaser Certicate ID number has already been assigned

to this business, check Yes and list the account number(s) in B and/or C.

If per Section A of the application your business was required to re-register for new accounts, or a Coal Severance/Processing Tax Account number or a

Coal Seller/Purchaser Certicate ID number was never assigned to your business, check No and leave B blank.

95. Date Mining/Processing and/or Coal Brokering Began or Will Begin—Give the date mining/coal processing and/or coal brokering began or will begin in

Kentucky.

96. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate

box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and

list which account address you wish to use.

If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone

number for this address in this section. You may include a P. O. Box here.