Form 51a113(O) - Consumer'S Use Tax Return

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51A113(O) (7-13)
Read instructions on reverse
before completing return.
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
CONSUMER’S USE TAX RETURN
For Month of _____________________ , 20____
Type or Print
__ __ __ – __ __ – __ __ __ __
__ __ – __ __ __ __ __ __ __
Enter Applicable Number: SSN
FEIN
Name
Name and
Address
P.O. Box or Number and Street
City or Town
County
State
ZIP Code
Nature of
➤ Important: An accurate description of your business is necessary.
Business
(if any)
List All Purchases of Tangible Personal Property and Digital Property Subject to Use Tax
Date of
Sale Price of
Name and Address of Seller
Description of Property
Purchase
Property Purchased
$
(If additional space is needed, see reverse.)
1. Total sale price of tangible personal property and digital property subject to use tax ............. 1 $
2. Use tax (6% of Line 1) ...................................................................................................................... 2
3. Compensation (1 3/4% of first $1,000 of tax, 1.5% over $1,000)
(see instructions) (Compensation shall not exceed $50) ............................................................. 3
4. Tax due (Line 2 minus Line 3) ......................................................................................................... 4
5. Penalty (if any) (see instructions).................................................................................................... 5
6. Interest (if any) (see instructions) ................................................................................................... 6
7. Total amount due and payable (total of Lines 4, 5 and 6) ............................................................ 7 $
I declare, under the penalties of perjury, that this return (including any accompanying schedules and statements) has been examined
by me and to the best of my knowledge and belief is a true, correct and complete return.
Date
Taxpayer’s Signature
Make check payable to Kentucky State Treasurer.
Mail return with check to:
Department of Revenue
Frankfort, Kentucky 40619

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