42a813 12/07 - Kjda Annual Report Form - Kentucky Department Of Revenue 2007

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42A813 (12-07)
KJDA ANNUAL REPORT
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Calendar Year_____________
Business Name
KJDA Number
Kentucky Withholding
Account Number
Activation Date
1.
Total annual gross wages exclusive of any noncash
benefits paid to eligible KJDA employees only.
$
2. Total annual Kentucky KJDA assessments
claimed by your company. (Include pending
refunds requested for assessments not retained
by company.)
$
3. Total annual local KJDA assessments claimed
by your company, if applicable.
$
4. Total annual Kentucky tax withheld and reported
under this account number for all employees,
eligible and ineligible.
$
Please attach spreadsheet that lists for each eligible employee the following information:
•
name,
•
Social Security number,
•
state of residency,
•
annual gross wages paid exclusive of any noncash benefits,
•
amount of Kentucky state tax withheld for the year, and
•
amount of Kentucky KJDA assessment claimed for the year.
KJDA Annual Report is due by March 15 of each year.
Mail to:
Kentucky Department of Revenue
Tax Credits Section
P .O. Box 181, Station 52
Frankfort, KY 40602-0181
Fax to:
(502) 564-0058
E-mail to: KRC.WEBResponseEconomicDevelopmentCredits@ky.gov
Signature _______________________________________________
Date ___________________________________
Title ____________________________________________________
E-Mail _________________________________
Telephone Number ______________________________________
Fax Number ____________________________

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