Form 12a502 - Application For Certificate Of Subordination Of Kentucky Department Of Revenue Lien

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12A502
03/2008
APPLICATION FOR CERTIFICATE OF SUBORDINATION
OF KENTUCKY DEPARTMENT OF REVENUE LIEN
SEND TO:
Department of Revenue
FOR QUESTIONS OR ASSISTANCE:
Division of Collections
Legal Support Branch
P.O. Box 5222
Office: (502) 564-4921, Ext. 4436
Frankfort KY 40602
Fax:
(502) 564-7348
1.
Name, address and telephone number of person(s) applying for the certificate of subordina-
tion of lien.
____________________________________________________________________________
____________________________________________________________________________
2.
Name and COMPLETE address of person to whom the certificate IS TO BE MAILED.
___________________________________________________________________________
___________________________________________________________________________
3.
Name and address of person(s) the lien(s) filed against.
___________________________________________________________________________
___________________________________________________________________________
4.
Debtor's Social Security Number and Business Tax Numbers?
SSN: ____________________________________________________________________
Withholding Tax No.:________________________________________________________
Sales & Use Tax No.:________________________________________________________
Corporation Income: ________________________________________________________
Other: _____________________________________________________________________

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