Form 10a100-Fi - 2007 - Kentucky Tax Registration Application - Kentucky Department Of Revenue Page 3
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410A100-FI (3-07)
Page 3
FOR OFFICE USE ONLY
LLET
WH
SU
USE
CP
Yes
No
38
Is your corporation incorporated or limited liability entity organized under the laws of Kentucky with our Secretary of States'
Office?..............................................................................................................................................................................................................................................
39
Does or will your corporation or limited liability entity have its commercial domicile in Kentucky?...........................................................
Does or will your corporation or limited liability entity own or lease any real or tangible personal property located in
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Kentucky? ............................................................................................................................................................................................................................................
41
Does or will your corporation or limited liability entity have one or more individuals performing services in Kentucky? .................
42
Does or will your corporation or limited liability entity maintain an interest in a pass-through entity doing business in
Kentucky? ......................................................................................................................................................................................................................................
43
Does or will your corporation or limited liability entity derive income from or attributable to sources within Kentucky,
including deriving income directly or indirectly from a trust or a single-member limited liability company doing business in
Kentucky?.......................................................................................................................................................................................................................................
Does or will your corporation or limited liability entity direct activities at Kentucky customers for the purpose of selling them
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goods or services? ......................................................................................................................................................................................................................
Does your corporation or limited liability entity own or lease any intangible property or receive payments from either a
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related member as defined in KRS 141.205(1)(g) or any unrelated party for the use of intangible property in Kentucky such as
royalties, franchise agreements, patents, trademarks, etc.?........................................................................................................................................
IF YOU ANSERED "YES" TO ANY OF QUESTIONS 38 THROUGH 45:
And your company is a corporation, S corporation, or an entity that has elected to be taxed as a corporation or S Corporation for federal
income tax purposes, you must complete SECTION G AND H.
-OR-
Your company is a limited partnership (LP), limited liability partnership (LLP), limited liability company (LLC), professional limited liability
company (PLLC), or similar entity that affords any of its partners, members, shareholders, or owners, through function of laws of Kentucky or
laws recognized by Kentucky, protection from general liability for actions of the entity and have not elected to be taxed as a corporation or S
corporation for federal income tax purposes, you must complete SECTION H.
-OR-
Your company is a qualified homeowner's association, REIT, RIC, REMIC, FASIT, or other entity not subject to the tax imposed by KRS
141.0401(6), you must complete SECTION G.
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Did you purchase an existing business? (See instructions).........................................................................................................................................
SECTION D
EMPLOYER'S WITHHOLDING ACCOUNT
(Must be completed if you answered "Yes" to question 24 OR 25, or you are registering for an additional account.)
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Number of employees in Kentucky
48
Date wages first paid or will be paid (required)
49
Estimated quarterly withholding in Kentucky
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Send mail related to this account to
Same address as in Page 1, Section B, Item 7
Street
Mailing address ATTN:
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County
City
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Mail address telephone
State
Zip Code
SECTION E
SALES AND USE TAX ACCOUNT
(Must be completed if you answered "Yes" to ANY of questions 26 through 33G, or you are registering for an additional account. )
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Date sales began or will begin (required)
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Accounting method
Cash
Accrual
Do you rent temporary lodging to others?
55
Yes
No
Do you sell new tires for motor vehicles?
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Yes
No
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Estimated gross monthly sales
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Send mail related to this account to
Same address as in Page 1, Section B, Item 7
Street
Mailing address ATTN:
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City
County
60
State
Zip Code
Mail address telephone
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