Form 41a720cell Draft - Schedule Cell - Application And Credit Certificate Of Income Tax/llet Credit Cellulosic Ethanol - 2017

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CELL
A
C
C
PPLICATION AND
REDIT
ERTIFICATE
*1700010298*
2017
O
I
T
LLET C
F
NCOME
AX/
REDIT
CELLULOSIC ETHANOL
Commonwealth of Kentucky
Department of Revenue
ä See instructions.
KRS 141.422 to 141.4248
103 KAR 15:120
ä Attach to Form 720, 720S, 725, 740, 740-NP , 741, 765, or 765-GP .
Name of Entity
Federal Identification
Kentucky Corporation/LLET
Number
Account Number (if applicable)
__ __ __ __ __ __
__ __ __ __ __ __ __ __ __
Mailing Address
Taxed as:
Corporation
Limited Liability Pass-through Entity
Location Address
General Partnership
Individual
Other
Kentucky Special Fuels Dealer’s License Account Number _______________________________________
At anytime during this calendar year, did your cellulosic ethanol fail to meet the ASTM standard?
Yes
No
If yes, list dates ________________________________________________________________________________
Part I—Gallons Produced in Kentucky During the Calendar Year
1. Number of gallons of cellulosic ethanol produced meeting ASTM standard ......................... 1
I, the undersigned, declare under the penalties of perjury, that I have examined this application, including all accompanying schedules and
statements, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature
Title
Date
Contact Name (if different from signer)
Email Address
Telephone Number
Fax Number
Department of Revenue Use Only
Part II—Cellulosic Ethanol Gallons Approved
1. Cellulosic Ethanol gallons approved by Department of Revenue ....................................... 1
Part III—Cellulosic Ethanol Approved Credit Certificate
1. (a) Approved credit for cellulosic
(
)
(a)
ethanol producer (numerator) ......... (a)
x * $
=
(b) Total approved credit for cellulosic
(b)
ethanol producer (denominator) ..... (b)
Approved Credit
By: ____________________________________________ Date: ________________________
* The cellulosic ethanol credit cap of $5,000,000 will be increased by the unused cap of the ethanol tax credit if the total
approved applications for the cellulosic ethanol tax credit exceeds its $5,000,000 cap.
TAXPAYER USE ONLY
Part IV—Cellulosic Ethanol Credit Used By Taxpayer
1. LLET Credit—Enter on Schedule TCS, Part II, Column E ..........................................................................1
2. Corporation Income Tax Credit—Enter on Schedule TCS, Part II, Column F ..........................................2
3. Individual Income Tax Credit—Enter on Form 740, 740–NP , or 741 ..........................................................3
No Carryforward Allowed
41A720CELL (19JUN17-DRAFT)
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