Form 42a814 Kira Annual Report - Kentucky 2007

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42A814 (12-07)
KIRA ANNUAL REPORT
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Calendar Year_____________
Business Name
KIRA Number
Kentucky Withholding
Account Number
Activation Date
1.
Total annual gross wages subject to income tax
paid to eligible KIRA employees only.
$
2. Total annual Kentucky KIRA assessments
claimed by your company. (Include pending
refunds requested for assessments not retained
by company.)
$
3. Total annual local KIRA 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 subject to income tax paid,
amount of Kentucky state tax withheld for the year, and
amount of Kentucky KIRA assessment claimed for the year.
KIRA 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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