Form 42a801(D) (4-08) - Amended Employer'S Return Of Income Tax Withheld

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42A801(D) (4-08)
K-1
AMENDED EMPLOYER’S RETURN OF
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
INCOME TAX WITHHELD
NAME AND ADDRESS
FOR OFFICIAL USE ONLY
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 ............
EXPLANATION OF CHANGES
3. Previous period
adjustments or
credits ...................
4. Net tax due ...........
5. Penalty (see
instructions) ..........
6. Interest (see
instructions) ..........
7 . Total penalty
and interest
(line 5 plus
line 6) ....................
8. Total amount due
(line 4 plus
line 7) ...................
Credit forward to
Refund requested $ __________________
____________________________ period
I declare, under the penalties of perjury, that this return has been examined
by me and to the best of my knowledge and belief is a true, correct and
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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