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Form 42a808 - Authorization To Submit Annual Employee Wage And Tax Statements Via File Transfer Protocol

42A808 (12-02)

Commonwealth of Kentucky

Authorization to Submit Annual Employee

REVENUE CABINET

Wage and Tax Statements Via File Transfer Protocol

1. Name, address and Kentucky withholding tax account number of person, organization or firm

requesting File Transfer Protocol (FTP)

Business Name ______________________________________________

FEIN* _____________________________

Street Address ___________________________________ City/State/ZIP __________________________________

2. Name, title and telephone number of contact person

Contact Name ____________________________________________

Phone Number _______________________

Title ____________________________________

E-mail Address** _____________________________________

3. Estimated number of employees to be reported via FTP ______________________________________________

4. Identification of the type of equipment: CPU ________________________

RAM ______________________

Operating System _________________________________

Internet Browser _____________________________

Does your office have a Firewall?

Yes

What kind of E-mail network are you connecting through? ____________________________________________

5. Have you received and installed the KRC-provided FTP Program from our Web site?

Yes

The address is

Signature of Person Completing Authorization

Date

Please submit the request to:

Kentucky Revenue Cabinet

Withholding Tax Section

P .O. Box 181, Station 57

Frankfort, KY 40602-0181

*If more than one FEIN is involved, please use the FEIN of the submitting/transmitting entity.

**This gives KRC permission to confirm the FTP status to the employer using the confidential e-mail address

provided on the form.

Please Note: It is important to get your system/network administrator involved immediately to ensure that you

have the proper FTP capabilities. KRC provides software, but there are often limitations in your system or network.

Please work with your system/network administrator early to ensure your success!

Form 42a808 - Authorization To Submit Annual Employee Wage And Tax Statements Via File Transfer Protocol