Form 42a803(D) (4-08) - Amended Employer'S Return Of Income Tax Withheld

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42A803(D) (4-08)
K-3
AMENDED EMPLOYER’S RETURN OF
Commonwealth of Kentucky
1
2
3
INCOME TAX WITHHELD
DEPARTMENT OF REVENUE
FOR OFFICIAL USE ONLY
NAME AND ADDRESS
AMENDED RETURN
Period Beginning:
Period Ending:
Return Due:
Account No.:
A
B
As Originally
Correct
Reported or Adjusted
Amount
1. Total wages paid
A
B
As Originally Reported or Adjusted
Correct Amount
this period ............
Total Number of Employees This Period
2. Kentucky income
tax withheld
this period ............
ANNUAL RECONCILIATION
3. Previous period
adjustments or
9. Total wages
credits ...................
paid for
the year ...............
4. Net tax due ...........
10. Total Kentucky
5. Penalty (see
income tax
instructions) ..........
withheld as
shown on K-2s ....
6. Interest (see
Col. A
Col. B
Col. A
Col. B
instructions) ..........
Monthly
Payments
Monthly
Payments
7 . Total penalty
Payments
By Quarter
Payments
By Quarter
and interest
Jan.
______________
(line 5 plus
______________
line 6) ....................
Feb.
______________
______________
8. Total amount due
Mar.
______________
1st _________
______________
1st _________
(line 4 plus
Apr.
______________
______________
line 7) ...................
Credit forward to
May
______________
______________
Refund requested $ __________________
___________________________ period
June
______________
2nd _________
______________
2nd _________
EXPLANATION OF CHANGES
July
______________
______________
Aug.
______________
______________
Sept.
______________
3rd _________
______________
3rd _________
Oct.
______________
______________
Nov.
______________
______________
I declare, under the penalties of perjury, that this return has been examined
Dec.
______________
4th _________
______________
4th _________
by me and to the best of my knowledge and belief is a true, correct and
11. Total (line 11 must equal line 10) ........
$
complete return.
SIGN
HERE ➤
__________
_______________________
________________
SIGNATURE
TITLE
DATE
Remit total amount due. Make check payable to: Kentucky State Treasurer.
Mail to: Department of Revenue, Frankfort, Kentucky 40619.

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