Form 61a509 - Distilled Spirits Or Telecoms Property Tax Statement Lin - 2012

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Bill No. _________________________________
61A509 (1-12)
DISTILLED SPIRITS OR TELECOMS
Commonwealth of Kentucky
PROPERTY TAX STATEMENT
GNC No. _______________ Type Co.________
DEPARTMENT OF REVENUE
Date _______________________
_________
For County, School or Special Taxes
Assessment for ________ Taxes
Make Payment To: ________________________________________________
Name ____________________________________________________________
Return Tax Payment To:
Name ____________________________________________________________
_______________________________________________________________
Address __________________________________________________________
_______________________________________________________________
_______________________________________________________________
Address __________________________________________________________
_______________________________________________________________
City, State, ZIP Code ________________________________________________
Telephone Number ________________________________________________
Assessed
Real Estate
Assessed
Total Real
Tangible
Name of District
Tax Due
Tax Due
Value
Rate Per
Value
and Tangible
Rate Per
County/School/Special
Real Estate
Tangible
Real Estate
$100 Value
Tangible
Tax Due
$100 Value
Important: See Reverse
Total District Tax $

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