Form 62a310 - Summary Of Bonds Held By Kentucky Residents

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62A310 (9-04)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
SUMMARY OF BONDS
Office of Property Valuation
HELD BY KENTUCKY RESIDENTS
200 Fair Oaks Lane, Station 32
Frankfort, KY 40620
THIS REPORT MUST BE FILED WITH THE DEPARTMENT OF REVENUE BY FEBRUARY 15.
Name and Address of Reporting Company
As of January 1, 20 ____
Federal Employer Identification Number
__ __ — __ __ __ __ __ __ __
Kentucky Residents Holding Bonds
Number of
Value
CUSIP
Interest
Maturity
Face
Kentucky
of
Total Value
Number
Rate
Date
Value
Each
Residents
Total Number of Bonds
TOTAL
Held by Kentucky Residents _______________________________________
VALUE
$ ____________________________
I declare, under the penalties of perjury, that this report (including any accompanying schedules and statements) is correct and complete.
________________________________________________________
__________________________________________________
Signature of Taxpayer
Name of Preparer Other Than Taxpayer
(
________________________________________________________
__________________________________________________
Telephone Number of Taxpayer
Date
Questions should be addressed to the Personal Property Branch at (502) 564-8160.
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