Form 73a902 - Utility Gross Receipts License Tax (Ugrlt) Energy Exemption Annual Return Page 3
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373A902 (12-08)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
ESTIMATED TAX
PAID ON MONTHLY RETURNS
SCHEDULE OF ENERGY REPORTED ON
MONTHLY UTILITY GROSS RECEIPTS LICENSE TAX RETURNS
AMOUNT OF ENERGY PAID
TOTAL AMOUNT ON
DIRECTLY TO SCHOOL DISTRICT
MONTH
LINE 5B OF MONTHLY RETURN
OR VENDOR
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$ ___________________
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1. Total amount subject to tax.
$ _________________
2. Tax on energy or energy-producing fuels ( __% of Line 1).
$ _________________
3. Estimated tax reported on Part II, Line 6.
$ _________________
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