Form 42a818 - Kbi Annual Report
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142A818 (10-10)
*1000020316*
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Calendar Year_____________
KBI ANNUAL REPORT
KRS 154.32–010 to 100
Business Name
KBI Number
Kentucky Withholding
Account Number
Activation Date
1.
Total annual gross wages paid to eligible KBI
employees only.
$
2. Total annual KBI assessments imposed
by your company. (Include pending
refunds requested for assessments not
retained by company.)
$
3. Total annual Kentucky tax withheld and reported
under this account number for all employees,
eligible and ineligible.
$
Please attach a spreadsheet that lists for each eligible employee the following information:
•
name,
•
Social Security number,
•
state of residency,
•
annual gross wages paid,
•
amount of Kentucky state tax withheld for the year, and
•
amount of KBI assessments imposed for the year.
KBI Annual Report is due by March 15 of each year.
Mail to:
Kentucky Department of Revenue
Tax Credits Section
P .O. Box 181, Station 52
Frankfort, KY 40602-0181
Fax to:
(502) 564-0058
E-mail to: KRC.WEBResponseEconomicDevelopmentCredits@ky.gov
Signature _______________________________________________
Date __________________________________________
Title ____________________________________________________
E-Mail _________________________________________
Telephone Number ______________________________________
Fax Number ___________________________________
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Parent category: Financial