➤ See instructions.
*0900010313*
SCHEDULE IEIA-T
41A720-S51 (10-09)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
T
S
RACKING
CHEDULE
F
AN IEIA P
OR
ROJECT
➤ Attach this schedule to Schedule IEIA.
KRS 154.27-010 to 090
Name of Entity
Entity Type
Corporation
Federal Identifi cation Number
Kentucky Corporation/LLET
Limited Liability Pass-through Entity
Account Number
General Partnership
__ __ — __ __ __ __ __ __ __
__ __ __ __ __ __
Other ___________________________________________
Location of Project
Date IEIA Incentive Agreement
Economic Development
was Executed
Project Number
_ _ / _ _ / _ _
City
County
Mo.
Day
Yr.
A
B
C
D
E
Taxable
Balance of Approved
Balance of Approved
IEIA
IEIA
Year Ended
Incentive for Wage
Incentive for Income
Wage Assessments
Tax Credit
Assessments
Tax and LLET
Withheld
Claimed