Form 10a100 - Kentucky Tax Registration Application printable pdf download

10A100 (10-11)

KENTUCKY TAX

FOR OFFICE USE ONLY

Commonwealth of Kentucky

REGISTRATION APPLICATION

DEPARTMENT OF REVENUE

CRIS

Coded

CTS CASE#

Date Coded

•

Incomplete or illegible applications will delay processing and will be returned.

•

Print or type the application using blue or black ink only.

CTS Person ID #

Data Entry

•

Please see instructions for questions regarding completion of the application.

•

Need Help? Call (502) 564-3306 or visit

NAICS

SIC

Date Data Entered

SECTION A

REASON FOR COMPLETING THIS APPLICATION (Must Be Completed)

1. Effective Date

2. Previous Account Numbers

(If Applicable)

 Opened new business

Kentucky Withholding Tax

 Resumption of business

Kentucky Sales and Use Tax

 Hired employees working in Kentucky

Kentucky Corporation Income Tax

 Hired employees working out-of-state with a KY residence

Kentucky Limited Liability Entity Tax

 Applying for additional tax accounts/Began new taxable activity

Kentucky Coal Severance Tax

 Bidding for State Government Contract (State Vendor or Affiliates)

Federal ID Number (FEIN)

3. Current Account Numbers

(If Applicable)

 Other (Specify)

Change in Ownership

Kentucky Withholding Tax

 Ownership type change–Previous type

Kentucky Sales and Use Tax

 Purchased an existing business (See Instructions)

Kentucky Corporation Income Tax

Kentucky Limited Liability Entity Tax

To update information for your existing account(s) or report

Kentucky Coal Severance Tax

opening a new location of your current business, use Form

10A104, Update or Cancellation of Kentucky Tax Accounts.

SECTION B

BUSINESS / RESPONSIBLE PARTY / CONTACT INFORMATION (Must Be Completed)

4. Legal Business Name

5. Doing Business As (See Instructions)

6. Federal Employer Identification Number (FEIN)

7. Kentucky Secretary of State Organization Number

(Required, complete prior to submitting)

(If applicable)

—

8. Business Location

9. Location of Business Records

Use the same address as listed in Item 8

Street Address (DO NOT List a PO Box)

City

State

Zip Code

City

State

Zip Code

Telephone Number

County (if in Kentucky)

Telephone Number

County (if in Kentucky)

(

)

–

(

)

–

10. Accounting Period

 Calendar Year (year ending December 31

)  Fiscal Year (year ending

(mm/dd))

11. Ownership Type

 Cooperative

 Sole Proprietorship

 Association

 Real Estate Investment Trust

 General Partnership

 Homeowner’s Association

 Estate

 Other (See Instructions)

 Corporation

 Joint Venture

 Limited Partnership

 S Corporation

 Trust

 Limited Liability Partnership (LLP or LLLP)

 Government

 Non-Profit

 Limited Liability Company (LLC)

12. If “LIMITED LIABILITY COMPANY” is Checked Above, How Will You be Taxed for Federal Purposes?

Single Member-Disregarded Entity, member taxed as:



 A. Partnership

 C. S Corporation

 E. Individual

 B. Corporation

 D. Non-Profit

 F. Other (Specify)

13–14. OWNERSHIP DISCLOSURE–RESPONSIBLE PARTIES (REQUIRED FOR ALL OWNERSHIP TYPES)

Full Legal Name (Last, First, Middle)

Residence Address

City

State

Zip Code

City

State

Zip Code

Social Security Number (REQUIRED)

Telephone Number

Social Security Number (REQUIRED)

Telephone Number

(

)

–

(

)

–

Business Title

Effective Date of Title

Business Title

Effective Date of Title

15. Person to contact regarding this application:

Name (Last, First, Middle)

Title

Daytime Telephone

Extension

(

)

–

E-mail: (By supplying your e-mail address you give the Department

of Revenue permission to contact you via E-mail.)

Form 10a100 - Kentucky Tax Registration Application

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