Form 51a400 - Governmental Public Facility Sales Tax Rebate Registration 2010
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151A400 (6-10)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
GOVERNMENTAL PUBLIC FACILITY
SALES TAX REBATE REGISTRATION
Name of Governmental Entity (please print or type)
Name of Public Facility
Name
Public Facility
Location Address
Number and Street
City
County
State
ZIP Code
Mailing
Address
(if different)
Number and Street
City
County
State
ZIP Code
(1) Sales and Use Tax Account Number(s) Used to Report Public Facility Sales: ______________________________________________
(2) Will there be third party vendor sales of admissions to the public facility or the sale of tangible personal property at the public
facility?
Yes
No
(3) Facility Description: ___________________________________________________________________________________________
____________________________________________________________________________________________________________
(a) Seating Capacity ______________________________
(b) County Population _________________________________
(c) Description of Planned Events _______________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
(d) Description of Sales That Are Subject to Rebate _________________________________________________________________
________________________________________________________________________________________________________
(e) Date Facility Opened/Plans to Open __________________________________________________________________________
Sales and use tax records and receipts from events held at the public facility must be maintained and submitted to substantiate quarterly claims
for refund in accordance with KRS 139.533.
I, the undersigned, have reviewed and understand KRS 139.533 in regard to the Kentucky Sales Tax Governmental Facility Rebate process.
To the best of my knowledge and belief, the statements contained on this registration are complete and accurate, and I am duly authorized to
sign this registration.
Contact Information:
Name
: _____________________________________
Title: ________________________________________
(please print or type)
Phone: ___________________________________________________
E-mail: ______________________________________
Signed: __________________________________________________
Date: ________________________________________
Return to Department of Revenue, Division of Sales and Use Tax, P.O. Box 181, Frankfort, Kentucky, 40602-0181
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