Form 10a104 - Update Or Cancellation Of Kentucky Tax Account(S) - 2017
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410A104 (06-17)
UPDATE OR CANCELLATION OF KENTUCKY TAX ACCOUNT(S)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
FOR OFFICE USE ONLY
CRIS
Coded / Entered / Date
•
Incomplete or illegible updates will delay processing and will be returned.
•
See instructions for questions regarding completion of this form.
Commonwealth Business Identifier (CBI)
NAICS
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Need Help? Call (502) 564-2694 or visit
Federal Employer Identification Number (FEIN)
SECTION A
REASON FOR COMPLETING THIS UPDATE (Must Be Completed)
/
/
This Form may only be used to update current account information.
2. Effective Date
To apply for additional accounts or to reinstate previous account
Check all that apply.
numbers, use Form 10A100, Kentucky Tax Registration Application.
Update business name or DBA name
Update an existing location’s information for the
1. Current Account Numbers
Sales and Use Tax Account
Close a location of current business for the Sales and Use Tax
Kentucky Employer’s Withholding Tax ____________________________
Account
Kentucky Sales and Use Tax ___________________________________
Open a new location of current business for the Sales and Use
Kentucky Telecommunications Tax ______________________________
Tax Account
Kentucky Utility Gross Receipts License Tax _______________________
Add a mine location to an existing Coal Tax Account
Kentucky Consumer’s Use Tax _________________________________
Change accounting periods
Kentucky Corporation Income Tax and/or
Change taxing election
Kentucky Limited Liability Entity Tax ___________________________
Update/provide new responsible party information
Kentucky Coal Severance and Processing Tax _____________________
Update mailing address(es) / mailing address telephone number(s)
Kentucky Pass-Through Non-Resident WH ________________________
Request cancellation of an account
SECTION B
BUSINESS AND CONTACT INFORMATION (Must Be Completed)
3. Legal Business Name
Current Name
New Name (if applicable)
________________________________________________________
________________________________________________________________
________________________________________________________
__________________________________________________________
4.
Doing Business As (DBA) Name
Current DBA
New DBA
________________________________________________________
________________________________________________________________
5.
Federal Employer Identification Number (FEIN)
6. Kentucky Secretary of State Organization Number
(Required, complete prior to submitting)
(If applicable)
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7.
Commonwealth Business Identifier (CBI)
8.
Person to Contact Regarding this Update Form:
Name (Last, First, Middle)
Title
Daytime Telephone
Extension
(
)
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E-mail: (By supplying your e-mail address you grant the Department
of Revenue permission to contact you via E-mail.)
SECTION C
ADD A NEW MINE LOCATION TO AN EXISTING COAL TAX ACCOUNT
9.
LIST THE MINE LOCATIONS THAT YOU OPERATE IN KENTUCKY
Mine Name
Surface Disturbance Mining Permit Number (if available)
Mine Number
Contract Miner Business Name (if available)
Mine Location (County)
Contract Miner Federal Employer Identification Number (FEIN)(if available)
10. Do you operate additional mine locations? Yes No
If yes, attach a listing of the information in Question 9 for each Kentucky mine location.
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Parent category: Financial