Form 51a242 - Application For Sales And Use Tax Refund For Motion Picture Production Company
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1
251A242 (5-07)
Important: Read instructions on
Commonwealth of Kentucky
reverse before completing.
DEPARTMENT OF REVENUE
APPLICATION
FOR SALES AND USE TAX REFUND
FOR MOTION PICTURE PRODUCTION COMPANY
Name
(
)
Enter Exact Name of Movie Production Company (please print or type)
Telephone Number (include area code)
Permanent
Location
Number and Street
City or Town
State
ZIP Code
Mailing Address
(If different)
Number and Street
City or Town
State
ZIP Code
(1) Did you notify the Department of Revenue of your intention to film prior to the commencement of filming?
Yes
No
If “yes,” attach a copy of the registration form to this application.
(2) Date filming or production of motion picture was started in this state. _____________________________________________________
(3) Date filming or production of motion picture was completed in this state. __________________________________________________
(4) Title of motion picture for which refund is claimed. ____________________________________________________________________
_______________________________________________________________________________________________________________
(5) What is the expected theatrical release or television exhibition date of the motion picture? _____________________________________
(6) Name of Kentucky financial institution on which checks were drawn.
Name _________________________________________________________________________________________________________
Address _______________________________________________________________________________________________________
KY
City
___________________________________________________ State ____________________ ZIP Code
_______________
(7) Name of individual and the address of the Kentucky location at which records of expenditures were maintained.
Name _________________________________________________________________________________________________________
Address _______________________________________________________________________________________________________
KY
City
___________________________________________________ State ____________________ ZIP Code
_______________
(8) Attach the final expenditure report to this application with copies of pertinent invoices, if applicable.
I, the undersigned, do declare under penalties of perjury that I have examined this application (including any accompanying statements or schedules
and reports) and to the best of my knowledge and belief, the information and statements regarding the refundable credit for sales and use taxes paid
on purchases made in connection with filming or producing motion pictures in Kentucky contained herein are true, complete and correct, and that I
am duly authorized to sign this application. The undersigned certifies that no tax liability of any kind is due the Commonwealth of Kentucky by this
applicant.
Signed _____________________________________________________
Title __________________________________________
Date
______________________________________________________
(Print or Type)
Return to Department of Revenue, Division of Sales and Use Tax, P.O. Box 181, Frankfort, Kentucky 40602-0181.
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