Form 61a208 - Public Service Company Property Tax Return Coin-Operated Telephones - State Of Kentucky

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61A208 (11-04)
Commonwealth of Kentucky
Due By
DEPARTMENT OF REVENUE
PUBLIC SERVICE COMPANY
Office of Property Valuation
APRIL 2005
Public Service Branch
PROPERTY TAX RETURN
S
M
T
W
T
F
S
200 Fair Oaks Lane, Fourth Floor
1
2
COIN-OPERATED TELEPHONES
3
4
5
6
7 8
9
Station 32
10 11 12 13 14 15 16
Frankfort, Kentucky 40620
17 18 19 20 21 22 23
24 25 26 27 28 29 30
(502) 564-8175
30
For Tax Year 2005
Federal ID Number ____________________________________________
Kentucky Sales and Use Account Number ________________________
Social Security Number ________________________________________
Type of Ownership
!
!
!
Foreign
Corporation
Partnership
COT
!
!
!
Individual
S Corporation
LLC
!
Other:
Taxpayer Name 1
LEAVE BLANK
Name 2
GNC
Address 1
Postmark
Address 2
Pre-Audit
City
State
ZIP Code
Contact Person
Phone
Fax
E-Mail
For agents, etc., a current
(
)
(
)
power of attorney must
Tax Agent Name 1
be on file with the
Kentucky Department of
Name 2
Revenue.
Address 1
Address 2
City
State
ZIP Code
Contact Person
Phone
Fax
E-Mail
(
)
(
)
Which address above is to be used for mailing the assessment notice, tax bills and certifications?
!
!
Taxpayer Address
Other __________________________________________________________________
!
___________________________________________________________________
Tax Agent Address
!
!
Have you sold any coin phones/locations to another organization or individual within the past year?
Yes
No
If yes, submit an informational report explaining the sale.
!
!
Have you purchased coin phones of another organization or individual within the past year?
Yes
No
If yes, submit an informational report explaining the purchase.
I declare under the penalties of perjury 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
Date
(See Reverse)

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