Form 41a720bio - Schedule Bio - Application And Credit Certificate Of Income Tax/llet Credit Biodiesel - 2016

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2016
SCHEDULE BIO
*1600030219*
41A720BIO (10–16)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
A
C
C
O
I
T
LLET C
PPLICATION AND
REDIT
ERTIFICATE
F
NCOME
AX/
REDIT
B
IODIESEL
KRS 141.422 to 141.425
➤ See instructions.
103 KAR 15:140
➤ 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 biodiesel or renewable diesel fail to meet the ASTM standard?
Yes
No
If yes, list dates ________________________________________________________________________________
Part I—Gallons Produced and/or Blended in Kentucky During the Calendar Year
1. Number of gallons of B100 biodiesel produced meeting ASTM standard .............................. 1
2. Number of gallons of B100 biodiesel blended with diesel*...................................................... 2
* A blender shall provide proof that the B100 as part of the blended biodiesel
meets the ASTM standard.
3. Number of gallons of renewable diesel produced meeting ASTM standard .......................... 3
4. Total biodiesel produced and/or blended and renewable diesel produced
(add lines 1, 2 and 3) .................................................................................................................... 4
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—Biodiesel Gallons Approved
1. Biodiesel gallons approved by Department of Revenue ...................................................... 1
Part III—Biodiesel Approved Credit Certificate
1. (a) Approved credit for biodiesel
(
)
producer and/or blender (numerator) ......... (a)
(a)
x $10,000,000 =
(b) Total approved credit for biodiesel
(b)
producer and/or blender (denominator) .... (b)
Approved Credit
By: ____________________________________________ Date: ________________________
TAXPAYER USE ONLY
Part IV—Biodiesel 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

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