Form 765 - Kentucky Partnership Income And Llet Return - 2015 Page 2
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5Form 765 (2015)
Page 2
*1500030264*
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
PART III—EXPLANATION OF FINAL RETURN AND/OR SHORT–PERIOD RETURN
¨ Ceased operations in Kentucky
¨ Change in filing status
¨ Change of ownership
¨ Merger
¨ Successor to previous business
¨ Other _________________________________________________
PART IV—EXPLANATION OF AMENDED RETURN CHANGES
I, the undersigned, declare under the penalties of perjury, that I have examined this return, including all accompanying schedules and statements,
and to the best of my knowledge and belief, it is true, correct and complete.
✍
Signature of partner or member
SSN or FEIN
Date
Printed name of partner or member
Name of person or firm preparing return
SSN, PTIN or FEIN
Date
May the DOR discuss this return with the preparer?
Federal Form 1065, all pages and
Yes
No
any supporting schedules must
Email Address:
be attached.
Telephone No.:
Make check payable to:
Kentucky State Treasurer
Mail to:
REFUNDS OR NO TAX DUE
Kentucky Department of Revenue, Frankfort, KY 40618-0010
PAYMENTS
Kentucky Department of Revenue, Frankfort, KY 40620-0020
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