Form 10a100 - Kentucky Tax Registration Application Page 3
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4Page 3
FOR CABINET USE ONLY
WH
CORP
COAL
SU
SU
BUS
BUS
BUS
BUS
__
__
__
A
B
C
SECTION 4
Complete if applying for Coal Severance and Processing Tax Registration (Continued)
4. Do you operate only as a contract miner, mining coal
9. List in the table below the information requested on each
belonging to others? (see instructions)
mine operated. Attach separate list if necessary.
Yes
No
10. Are you entitled to the depletion allowance under Section
If “Yes,” for whom?
611 of the Internal Revenue Code?
Yes
No
If “No,” who is entitled to the depletion allowance?
Name
Address
Name
City
State
ZIP Code
Address
5. Do you operate a tipple or processing plant?
City
State
ZIP Code
Yes
No
If “Yes,” give location(s). Attach separate schedule if
11. Do you own or operate any other coal mining, coal
additional space is needed.
processing (tipple, etc.), or coal brokerage company?
Yes
No
If “Yes,” list name and address.
Name
6. Do you purchase coal for the purpose of processing
Address
(cleaning, breaking, sizing, dust allaying, treating to
prevent freezing or loading for shipment) and resale?
City
State
ZIP Code
Yes
No
12. List name(s) and address(es) of persons to whom you sell
7. Do you purchase coal solely for the purpose of resale with
coal. Attach separate schedule if necessary.
no processing involved?
Yes
No
8. If the answer to question 1 under this section is “Yes,” do
Name
you also operate as a contract miner, mining coal
Address
belonging to others?
Yes
No
If “Yes,” for whom?
City
State
ZIP Code
13. Date mining or processing operation began or will begin.
Name
Address
__ __ / __ __ / __ __
Mo.
Day
Yr.
City
State
ZIP Code
Mine
Surface Disturbance
Kentucky Department of Mines
MSHA
Location
Name
Mining Permit Number
and Minerals File Number
Identification Number
(County)
15–
15–
15–
15–
SECTION 5
Complete if applying for (check one) :
Sales and Use Tax Permit or
Consumer Registration Number
5. Mailing address for sales and use tax returns
1. Give the date that sales or purchases of tangible personal
property began or will begin in Kentucky.
Mail to
__ __ / __ __ / __ __
Mo.
Day
Yr.
2. Check accounting method to be used in reporting total
Street address or post office box or route number
receipts.
Cash
Accrual
3. If you have more than one business location, do you wish
to file a consolidated return for all locations or a separate
City
State
ZIP Code
return for each location?
Separate
Consolidated
4.
Do you make retail sales of new tires for motor vehicles
County
Telephone (include area code)
within Kentucky?
Yes
No
PAGE 4, SECTION 6 MUST BE COMPLETED
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