Form 41a720eth Draft - Schedule Eth - Application And Credit Certificate Of Income Tax/llet Credit Ethanol - 2017

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ETH
*1700010299*
A
C
C
PPLICATION AND
REDIT
ERTIFICATE
2017
O
I
T
LLET C
F
NCOME
AX/
REDIT
ETHANOL
Commonwealth of Kentucky
Department of Revenue
ä See instructions.
KRS 141.422 to 141.4248
103 KAR 15:110
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
General Partnership
Location Address
Individual
Other
Kentucky Special Fuels Dealer’s License Account Number _______________________________________
At anytime during this calendar year, did your 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 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—Ethanol Gallons Approved
1. Ethanol gallons approved by Department of Revenue ......................................................... 1
Part III—Ethanol Approved Credit Certificate
1. (a) Approved credit for ethanol
(
)
(a)
producer (numerator) ......................(a)
x * $
=
(b) Total approved credit for ethanol
(b)
producer (denominator) ................ (b)
Approved Credit
By: ____________________________________________ Date: ________________________
* The annual ethanol tax credit cap of $5,000,000 will be increased by the unused cap of the cellulosic ethanol tax credit
if the total approved applications for the ethanol tax credit exceeds its $5,000,000 cap.
TAXPAYER USE ONLY
Part IV—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
41A720ETH (19JUN17-DRAFT)
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