Form 740np-Wh - Kentucky Nonresident Income Tax Withholding On Distributive Share Income Report And Composite Income Tax Return - 2011
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1
22011
740NP-WH
*1100020292*
Taxable Year Ending
40A201 (10-11)
__ __ / __ __
Mo.
Yr.
Check if
Composite Income Tax Return
KENTUCKY NONRESIDENT INCOME TAX WITHHOLDING ON
Amended Return
DISTRIBUTIVE SHARE INCOME REPORT
Estimated Payment
AND COMPOSITE INCOME TAX RETURN
Extension Payment
(To be completed by Pass-through Entities Only)
Change of address
Taxable period beginning _______________, 2011, and ending _______________, 201___.
(1) Federal Identification Number
(2) Kentucky Corporation/LLET Account Number
(3) Name of Pass-through Entity
Street Address
City
State
ZIP Code
(4) Number of nonresident individuals, estates, trusts and C corporations subject to withholding
4
(5) Number of nonresident individuals, estates, and trusts subject to income tax (composite return only)
5
(6) Kentucky distributive share income before apportionment (see instructions)
6
00
(7) 100% or the apportionment factor from Schedule A, Section I,
%
line 12
7
(8) Kentucky distributive share income subject to withholding/income tax
(line 6 multiplied by line 7)
8
00
(9) Tax before credit (line 8 multiplied by .06 (6%))
9
00
(10) Enter pass-through partners’, members’ or shareholders’ non-
refundable credits (attach schedule)
10
00
(11) Kentucky income tax due (line 9 less line 10)
11
00
(12) Amount paid (see instructions)
12
00
(13) Balance of tax due. If line 11 is greater than line 12, enter line 11 less line 12.
13
00
(14) Tax overpayment. If line 11 is less than line 12, enter line 12 less line 11.
14
00
(15) Amount credited to 2012
15
00
(16) Amount to be refunded (line 14 less line 15)
16
00
TAX PAYMENT SUMMARY
(Round to nearest dollar)
Make check(s) or money order(s)
payable to: Kentucky State Treasurer
Tax (Line (13))
1.
$_____________________________
Mail to:
Penalty
2.
$_____________________________
Kentucky Department of Revenue
Interest
3.
$_____________________________
Frankfort, KY 40619-0006
Total Payment
$_____________________________
4.
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.
Print name of partner, member or shareholder
Signature of partner, member or shareholder
Daytime telephone number
Date
Name of person or firm preparing return
Date
May the DOR discuss this return with the preparer?
Yes
No
Email Address:
SSN, PTIN or FEIN
Telephone No.:
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