Looking for a Kentucky Tax Forms And Templates? Download it for free!

10A100-FI (3-07)

Page 4

SECTION F

CONSUMER'S USE TAX ACCOUNT

(Must be completed if you answered "Yes" to ANY of questions 34 through 36.)

Date purchases began or will begin (required)

(If you make a one-time purchase only, see instructions.)

Send mail related to this account to

Same address as in Page 1, Section B, Item 7

Mailing address ATTN:

Street

County

City

State

Zip Code

Mail address telephone

SECTION G

CORPORATION INCOME TAX ACCOUNT

Date of incorporation or organization

State of incorporation or organization

Date of qualification in Kentucky

Send mail related to this account to

Same address as in Page 1, Section B, Item 7

Street

Mailing address ATTN:

County

City

Mail address telephone

State

Zip Code

SECTION H

LIMITED LIABILITY ENTITY TAX ACCOUNT

Date of incorporation or organization

State of incorporation or organization

Date of qualification in Kentucky

Send mail related to this account to

Same address as in Page 1, Section B, Item 7

Street

Mailing Address ATTN:

County

City

State

Zip Code

Mail address telephone

For assistance in completing the application, please call the Taxpayer Registration Section at (502) 564-3306, Monday through Friday between the

hours of 8 a.m. and 5:00 p.m., Eastern time, OR you may call or visit one of the following Kentucky Taxpayer Service Centers or the Telecommunication Device

for the Deaf. Each office is open Monday through Friday, 8:00 a.m. to 5:00 p.m., local time.

Ashland

(606) 920-2037

Northern Kentucky

(859) 371-9049

Bowling Green

Owensboro

(270) 746-7470

(270) 687-7301

Central Kentucky

(502) 564-4580

Paducah

(270) 575-7148

Corbin

(606) 528-3322

Pikeville

(606) 433-7675

Hopkinsville

Telecommunication

(270) 889-6521

Louisville

(502) 595-4512

Device for the Deaf

(502) 564-3058

Mail completed application consisting of ALL 4 pages to:

Kentucky Department of Revenue

P.O. Box 299, Station 20

Frankfort, Kentucky 40602-0299

OR fax application to:

(502) 227-0772

For Information about registering for coal severance tax, cigarette tax, minerals or natural gas severance tax, motor fuels tax, utility gross receipts license tax,

telecommunications tax or any tax administered by the Department of Revenue, please visit our Web site at

If you are applying for a withholding account and/or a sales and use tax account and would like to receive a packet to register for Electronic Funds Transfer (EFT), please

call (502) 564-6020.

The DOR has an Ombudsman's Office to serve as your advocate and is available to make sure your rights are protected. You may contact the Ombudsman's Office at

(502) 564-7822.

This form does not include registration for Unemployment Insurance or Workers' Compensation Insurance,. Please contact the Business Information Clearinghouse toll

free at 1-800-626-2250 (in Kentucky) or (502) 564-4252 (outside Kentucky) to obtain information on these taxes or contact the offices directly at the numbers below.

Unemployment Insurance

(502) 564-2272

Secretary of State

(502) 564-2848

Workers' Compensation

(502) 564-5550

IRS - FEIN

(800) 829-4933

The Kentucky Department of Revenue does not discriminate on the basis of race, color, national origin, sex,

religion, age or disability in employment or the provision of services.