Form 51a113(O) - Consumer'S Use Tax Return - 2001
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1
251A113(O) (4-01)
Read instructions on reverse
before completing return.
Commonwealth of Kentucky
CONSUMER’S USE TAX RETURN
REVENUE CABINET
For Month of _____________________ , 200____
Type or Print
__ __ __ – __ __ – __ __ __ __
__ __ – __ __ __ __ __ __ __
Enter Applicable Number: SSN
FEIN
Name
Name and
Address
P.O. Box or Number and Street
City or Town
County
State
ZIP Code
Important: An accurate description of your business is necessary.
Nature of
Business
(if any)
List All Purchases of Tangible Personal Property Subject to Use Tax
Date of
Sale Price of
Name and Address of Seller
Description of Property
Purchase
Property Purchased
$
(If additional space is needed, see reverse.)
1. Total sale price of tangible personal property subject to use tax .............................................. 1 $
2. Use tax (6% of Line 1) .................................................................................................................... 2
3. Compensation (1 3/4% of first $1,000 of tax, 1% over $1,000) (see instructions) ..................... 3
4. Tax due (Line 2 minus Line 3) ....................................................................................................... 4
5. Penalty (if any) (see instructions) ................................................................................................. 5
6. Interest (if any) (see instructions) ................................................................................................. 6
7. Total amount due and payable (total of Lines 4, 5 and 6) .......................................................... 7 $
I declare, under the penalties of perjury, that this return (including any accompanying schedules and statements) has been exam-
ined by me and to the best of my knowledge and belief is a true, correct and complete return.
Date
Taxpayer’s Signature
Make check payable to Kentucky State Treasurer.
Mail return with check to: Revenue Cabinet
Frankfort, Kentucky 40619
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