Form 41a800 - Corporation And Pass-Through Entity Nexus Questionnaire

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41A800 (12-15)
Commonwealth of Kentucky
CORPORATION AND PASS-THROUGH ENTITY
DEPARTMENT OF REVENUE
NEXUS QUESTIONNAIRE
The term “you” is defined to mean the taxpayer or an agent of the taxpayer.
Please explain all “YES” answers in detail and attach additional information, if necessary.
1.
Legal Name of Corporation or Pass-through Entity: ________________________
________________________________________________________________________
FEIN: __________________________________________________________________
Kentucky Corporation/LLET Account Number: _____________________________
2.
Home Office Mailing Address: ___________________________________________
________________________________________________________________________
________________________________________________________________________
3.
Location of Books and Records: __________________________________________
________________________________________________________________________
________________________________________________________________________
4.
Principal Product or Service in Kentucky: __________________________________
________________________________________________________________________
________________________________________________________________________
5.
Give State and Year of Incorporation or Organization:
________________________________________________________________________
6.
Date of Tax Year End: _____________________________________________________
7.
Is your business registered with the Kentucky Secretary of State to do
business in Kentucky?
¨
¨
YES
NO
If yes, give date: _________________________________________________________
8.
If the entity in Question 1 is a corporation, does any corporation own directly
or indirectly 80% or more of its voting stock?
¨
¨
YES
NO
If yes, enter the Name: ___________________________________________________
FEIN: ___________________________________________________________________
Address: ________________________________________________________________

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