Schedule Bio Template - Application And Credit Certificate Of Income Tax Credit Biodiesel

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*0600010219*
SCHEDULE BIO
20__ __
41A720BIO (10-06)
Commonwealth of Kentucky
Calendar Year
DEPARTMENT OF REVENUE
The credit shall not carry
forward for any other period.
➤ See instructions on reverse.
A
A
C
C
O
I
T
C
PPLICATION
ND
REDIT
ERTIFICATE
F
NCOME
AX
REDIT
B
IODIESEL
➤ Attach to Form 720, 720S, 725,
KRS 141.422 to 141.425; Regulation 103 KAR 15:140
740, 765 or 765-GP.
Name of Business/Individual
Identification
Kentucky Corporation
Number
Account Number
(if applicable)
Mailing Address
__ __ __ __ __ __
__ __ __ __ __ __ __ __ __
Location Address
Taxed as:
Corporation as defined in KRS 141.010(24)
Individual
General Partnership
Other _________________________
Kentucky Special Fuels Dealer's License Account Number ________________________________________
At anytime during this calendar year, did your biodiesel fail to meet the ASTM standard?
Yes
No
If yes, list dates ______________________________________________________________________________ .
PART I—Gallons Produced and/or Blended in Kentucky During the Calendar Year
1. Number of gallons of B100 biodiesel produced meeting ASTM standard ............................. 1
2. Number of gallons of B100 biodiesel blended with diesel* ..................................................... 2
* A blender shall provide proof that the B100 as part of the blended biodiesel
meets the ASTM standard.
3. Total biodiesel produced and/or blended (add lines 1 and 2) .................................................. 3
I, the undersigned, declare under the penalties of perjury, that I have examined this return, including all accompanying schedules and state-
ments, and to the best of my knowledge and belief, it is true, correct and complete.
Signature
Title
Date
Contact Name (if different from signer)
E-Mail Address
Telephone Number
Fax Number
NOTE: This credit cannot reduce the tax liability on Form 720, Form 720S, Form 725 or Form 765, Part III, line 3 below
the $175 minimum. There is no carryforward of unused credit.
Department of Revenue Use Only
Part II—Tax Credit
1. Biodiesel tax credit approved by Department of Revenue
(Part I, line 3 multiplied by $1 or Part III, line 1) ................................................................... 1
Part III—Annual Biodiesel Tax Credit Cap
1. (a) Approved credit for biodiesel
producer and/or blender (numerator) ........... (a)
(
)
x
$1,500,000 =
(b) Total approved credit for biodiesel
producer and/or blender (denominator) ...... (b)
Approved Credit
Corporations, enter on Schedule TCS, Part II.

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