Form 62a310 - Corporation Report Of Securities Held By Kentucky Residents printable pdf download

Form 62a310 - Corporation Report Of Securities Held By Kentucky Residents

CORPORATION REPORT OF SECURITIES

62A310 (12-01)

Commonwealth of Kentucky

REVENUE CABINET

HELD BY KENTUCKY RESIDENTS

Department of Property Valuation

200 Fair Oaks Lane, Station 32

Frankfort, KY 40620

COVER SHEET

THIS REPORT MUST BE FILED WITH THE REVENUE CABINET BY FEBRUARY 15.

Name and Address of Reporting Corporation

As of January 1, 20 ____

Federal Employee Identification Number

__ __ — __ __ __ __ __ __ __

Kentucky Account Number

__ __ __ __ __ __

Kentucky Residents Holding Bonds

Number of

Value

CUSIP

Interest

Maturity

Face

Kentucky

Total Value

Number

Rate

Date

Value

Each

Residents

Total Number of Securities

TOTAL

Held by Kentucky Residents _______________________________________

VALUE

$ ____________________________

CERTIFICATION

I, the undersigned, a principal officer of the above-named corporation, state under the penalties of perjury that this report of individual

holdings is to the best of my knowledge and belief, a true, correct and complete report made in good faith.

Signature

Title

Date

Questions should be addressed to the Personal Property Branch at (502) 564-8160.

Form 62a310 - Corporation Report Of Securities Held By Kentucky Residents