Form 51a160 - Application For Truck Part Direct Pay Authorization printable pdf download

51A160 (3-05)

APPLICATION FOR TRUCK PART

Commonwealth of Kentucky

DIRECT PAY AUTHORIZATION

DEPARTMENT OF REVENUE

Enter Legal Business Name

Federal Employer Identification No.

Name of

__ __ – __ __ __ __ __ __ __

Applicant

Trade or DBA Name

Business

Location

Principal Location Address

City

County

State

ZIP Code

Mailing

Address

Mailing Address

City

County

State

ZIP Code

(

)

(

)

Telephone Number

Fax Number

E-mail Address

Kentucky Account Numbers

Account

Kentucky Sales Tax*

Kentucky Employer's Withholding

Information

Kentucky Consumers Use Tax*

Kentucky Corporation Income

(*Applicant must have one of these accounts to qualify.)

and License

(1)

Provide a brief description of the Kentucky business activity.

_____________________________________________________________________________________

Other

(2)

Provide the applicant's USDOT Number. ____________________

Information

(3)

Indicate below how many motor vehicles the applicant owns or leases that will qualify for the repair and

replacement part exemption provided under KRS 139.480(32). To qualify, the vehicles must be (a) licensed

for highway use at a declared weight with any towed unit of 44,001 pounds or greater, (b) driven

exclusively in interstate routes involving more than one state (nominal intrastate use is allowed), and

Truck Tractors ____________

Trailers

____________

Other

____________

(Describe vehicle type) _____________________________________

(4)

Business records must track the amount of truck repair and replacement parts purchased from a Kentucky

vendor or from an out-of-state vendor for storage, use, or other consumption in this state. Attach a detailed

description of the documentation maintained that reflects the proper amount of taxable purchases.

I hereby certify that the above statements are correct to the best of my knowledge and belief and that I am duly authorized to sign this application. I agree

that, in consideration for issuance of this Truck Part Direct Pay Authorization, I will directly report and pay to the Department of Revenue, the sales or

use tax that would have been remitted to the department by my supplier had this Truck Part Direct Pay Authorization not been issued.

Mail to:

KY Department of Revenue

Signature

Title

Sales and Use Tax Division

P.O. Box 181

Print Name

Date

Frankfort, KY 40602-0181