Form 72a160 - Licensed Special Fuels Dealer'S Estimated Tax Payment - Kentucky Department Of Revenue - 2006

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72A160 (10-06)
FOR DEPARTMENT USE ONLY
LICENSED
Commonwealth of Kentucky
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SPECIAL FUELS DEALER’S
DEPARTMENT OF REVENUE
Account Number
Tax
Mo.
Yr.
ESTIMATED TAX PAYMENT
➤ Type or print clearly.
➤ Complete all information.
Name and Address of Dealer
License Number
Federal Employer ID Number
Estimated Tax for MM/YY
(
)
Contact Person
Telephone Number
INSTRUCTIONS
Kentucky Revised Statute 138.240 provides that the Licensed Special Fuels Dealer’s Monthly Report shall be filed on or before the
25th day of the next succeeding calendar month following the month to which it relates. KRS 138.270 further provides that 95 percent
of the report month’s tax liability may be remitted by the 25th day of the month and the report filed on or before the last day of the
month and the additional tax liability remitted with the report.
The month used to determine the estimated tax liability is the month for which you are requesting an extension.
1. Tax liability for the report month .................................................................................................................... $
2. Estimated tax (95% of line 1) (enter this amount on line 22, Form 72A138) ................................................ $
3. Less overpayment on last monthly report filed
(attach copy of credit authorization) ....................................................................... $
4. Amount of payment (line 2 minus line 3) .............................................................. $
IMPORTANT NOTICE
Make check payable to: KENTUCKY STATE TREASURER
Mail report and check to: KENTUCKY DEPARTMENT OF REVENUE, FRANKFORT, KENTUCKY 40619
CERTIFICATION
I hereby certify that this return (including any accompanying schedules and statements) has been examined by me and to the best of my
knowledge and belief is a true, correct and complete return.
________________________________________________________
_________________________________________
Signature
Title
________________________________________________________
_________________________________________
Print Name
Date

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