62A310-S1 (12-01)
CORPORATION REPORT OF SECURITIES
Commonwealth of Kentucky
HELD BY KENTUCKY RESIDENTS
REVENUE CABINET
As of January 1, 20 _____
Name of Issuing Corporation
Name, Address and Social Security Number of Holder
Description of Security
Number of
Market
Total
CUSIP
(Include Par Value, Interest Rate
Bonds Held
Market Value
Value
Number
)
and Maturity Date of Bonds
Bonds ....................
Bonds ....................
Bonds ....................
Other .....................
Submit One Copy Only
Detach Here
62A310-S1 (12-01)
CORPORATION REPORT OF SECURITIES
Commonwealth of Kentucky
HELD BY KENTUCKY RESIDENTS
REVENUE CABINET
As of January 1, 20 _____
Name of Issuing Corporation
Name, Address and Social Security Number of Holder
Description of Security
Number of
Market
Total
CUSIP
(Include Par Value, Interest Rate
Bonds Held
Market Value
Value
Number
)
and Maturity Date of Bonds
Bonds ....................
Bonds ....................
Bonds ....................
Other .....................
Submit One Copy Only
Detach Here
62A310-S1 (12-01)
CORPORATION REPORT OF SECURITIES
Commonwealth of Kentucky
HELD BY KENTUCKY RESIDENTS
REVENUE CABINET
As of January 1, 20 _____
Name of Issuing Corporation
Name, Address and Social Security Number of Holder
Description of Security
Number of
Market
Total
CUSIP
(Include Par Value, Interest Rate
Bonds Held
Market Value
Value
Number
)
and Maturity Date of Bonds
Bonds ....................
Bonds ....................
Bonds ....................
Other .....................
Submit One Copy Only