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Form 51a601 - Information Sharing And Assignment Agreement For Disaster Relief Refund Claims

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51A601 (8-12)

Commonwealth of Kentucky

INFORMATION SHARING AND ASSIGNMENT

DEPARTMENT OF REVENUE

AGREEMENT FOR DISASTER RELIEF REFUND CLAIMS

This information-sharing agreement and assignment agreement is hereby entered into between the Department of Revenue and the

following parties.

_______________________________________________________

Legal Building Owner

Contact Person _________________________________

Kentucky SU Tax Account # (if applicable) __________________

Address ______________________________________

_____________________________________________

Telephone Number ______________________________

E-mail Address _________________________________

_______________________________________________________

Vendor

Contact Person ________________________________

Kentucky SU Tax Account # _____________________________

Address ______________________________________

_____________________________________________

Telephone Number ______________________________

E-mail Address _________________________________

_______________________________________________________

Contractor/Subcontractor (Purchaser)

Contact Person ________________________________

Kentucky SU Tax Account # ______________________________

Address ______________________________________

_____________________________________________

Telephone Number ______________________________

E-mail Address _________________________________

Purpose

The purpose of this agreement is to facilitate the payment of refunds allowed a legal owner of a building damaged or destroyed in a

disaster area. According to the provisions of the applicable statutes, the owner may receive a refund of sales and use tax paid on the cost

of building materials used to repair or replace the building.

In order for the sales and use tax refund request to be properly verified and ultimately paid, various tax and purchase information

may be shared by and among the Department, the Legal Building Owner, Vendors, Contractors/Subcontractors (Purchaser) and other

related parties. To ensure the accomplishment of this process without any violation of the taxpayer confidentiality laws (KRS 131.190;

131.081(15); 131.990), the Legal Building Owner and other parties listed above hereby enter into this information-sharing agreement

pursuant to the above statutes.

An Equal Opportunity Employer M/F/D

Form 51a601 - Information Sharing And Assignment Agreement For Disaster Relief Refund Claims