Kentucky Tax Registration Supplemental Information Schedule Form
ADVERTISEMENT
1KENTUCKY TAX REGISTRATION
10A100-S (10-02)
DO NOT USE THIS SPACE
Commonwealth of Kentucky
SUPPLEMENTAL INFORMATION SCHEDULE
REVENUE CABINET
Name
FEIN/SSN
Address
Phone (
)
City
State
ZIP Code
ADDITIONAL LOCATIONS
o Sales and Use
o Withholding
Business Name __________________________________________________________________________________________
Street Address or Route Number _________________________________________________________________________
City ______________________________________________
State ___________
ZIP Code ________________________
(
)
County _____________________________________
Telephone Number ______________________________________
Were business assets purchased? o Yes
o No
NAICS Code
o Sales and Use
o Withholding
Business Name __________________________________________________________________________________________
Street Address or Route Number _________________________________________________________________________
City ______________________________________________
State ___________
ZIP Code ________________________
(
)
County _____________________________________
Telephone Number ______________________________________
Were business assets purchased? o Yes
o No
NAICS Code
o Sales and Use
o Withholding
Business Name __________________________________________________________________________________________
Street Address or Route Number _________________________________________________________________________
City ______________________________________________
State ___________
ZIP Code ________________________
(
)
County _____________________________________
Telephone Number ______________________________________
Were business assets purchased? o Yes
o No
NAICS Code
o Sales and Use
o Withholding
Business Name __________________________________________________________________________________________
Street Address or Route Number _________________________________________________________________________
City ______________________________________________
State ___________
ZIP Code ________________________
(
)
County _____________________________________
Telephone Number ______________________________________
Were business assets purchased? o Yes
o No
NAICS Code
ADDITIONAL OWNERS, MEMBERS, PARTNERS, OFFICERS
Name (Last, First, Middle or Business)
Title
Residence Address
Soc. Sec. No. or FEIN
Attach this additional information schedule to your completed Kentucky Tax Registration Application
and mail to: Kentucky Revenue Cabinet, P .O. Box 299, Frankfort, Kentucky 40602-0299.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial