Form 41a800 - Corporation And Pass-Through Entity Nexus Questionnaire Page 12
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1241A800 (12-15)
Page 12
The above responses apply to the period from _______________ to _______________. (Please give details
of any changes in the nature of the entity’s activity in Kentucky and specify the tax periods involved.)
PROVIDE ANY ADDITIONAL INFORMATION WHICH MAY BE USEFUL IN DETERMINING WHETHER YOU HAVE A
FILING REQUIREMENT FOR TAXES IN KENTUCKY.
Person completing questionnaire: ________________________________________________________
Title: _________________________________________________________________________________
Telephone: ____________________________________________________________________________
Email address:_________________________________________________________________________
Date: _________________________________________________________________________________
Please return this completed questionnaire to:
ATTN:
Division of Corporation Tax
Kentucky Department of Revenue
P . O. Box 181, Station 52
Frankfort, Kentucky 40602-0181
Telephone: 502-564-8139
Fax: 502-564-0058
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