Form 725 - Kentucky Single Member Llc Individually Owned Llet Return

Form 725 (2012)

Page 2

*1200020271*

Commonwealth of Kentucky

DEPARTMENT OF REVENUE

Q—S

CHEDULE

INGLE

EMBER

IMITED

IABILITY

OMPANY

UESTIONNAIRE

If yes, list name and federal I.D. of the pass-through

IMPORTANT: Questions 1—10 must be completed by the limited

liability company.

entity(ies).

______________________________________________________

1. Single member’s (owner) name, address and Social Security

______________________________________________________

number or federal I.D. number _________________________

______________________________________________________

Was the limited liability company doing business in Kentucky

______________________________________________________

other than through its interest held in a pass-through entity

______________________________________________________



doing business in Kentucky?

Yes

2. List the following Kentucky account numbers. Enter N/A

7. Is the entity filing this Kentucky tax return organized as a

for any number not applicable.

statutory trust or a series statutory trust as provided by KRS

Employer Withholding ________________________________



Chapter 386A?

Yes

Sales and Use Tax Permit _____________________________

If yes, is the entity filing this Kentucky tax return a series

Consumer Use Tax ___________________________________



within a statutory trust?

Yes

Unemployment Insurance _____________________________

If yes, enter the name, address and federal I.D. number of

Coal Severance and/or

the statutory trust registered with the Kentucky Secretary

Processing Tax ______________________________________

of State: ______________________________________________

3. If a foreign limited liability company, enter the date qualified

__ __

/ __ __ / __



8. Was this return prepared on: (a)

cash basis, (b)

accrual

to do business in Kentucky.



basis, (c)

other

_____________________________________

4. The limited liability company’s books are in care of: (name

9. Did the limited liability company file a Kentucky tangible

and address)

personal property tax return for January 1, 2013?

______________________________________________________



Yes

______________________________________________________

10. Is the single member limited liability company currently under

______________________________________________________



audit by the Internal Revenue Service?

Yes

5. Are disregarded entities included in this return?



Yes

If yes, enter years under audit

______________________________________________________

If yes, list name, address and federal I.D. number of the

entity(ies).

If the Internal Revenue Service has made final and

______________________________________________________

unappealable adjus tment s to the limited liabilit y

______________________________________________________

company’s taxable income which have not been reported

______________________________________________________



to this department, check here

and file Form 740X for tax

______________________________________________________

years 2005 through 2012 or Form 740-XP for 2004 and prior

tax years, whichever is applicable, and file an amended

Was the limited liability company a partner in a pass-through

Form 725 for each year adjusted. Attach a copy of the final

entity doing business in Kentucky for the tax year being

determination to each amended return.



reported?

Yes

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 member (owner)

SSN or FEIN

Date

Name of person or firm preparing return

SSN, PTIN or FEIN

Date

May the DOR discuss this return with the preparer?



Yes

Email Address:

Telephone No.:

Form 725 - Kentucky Single Member Llc Individually Owned Llet Return - 2012 Page 2

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