Form 41a800 - Corporation And Pass-Through Entity Nexus Questionnaire Page 4

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41A800 (12-11)
Page 4
g. Are you a member of a single member limited liability company that is doing
business in Kentucky and is disregarded for federal income tax purposes?
YES
NO
If yes, provide the name, identification number and address of each:
________________________________________________________________________
________________________________________________________________________
h. Are you a shareholder, partner, or member of a pass-through entity doing
business in Kentucky?
YES
NO
If yes, provide the name, identification number and address of each:
________________________________________________________________________
________________________________________________________________________
i.
Do you receive income from intangible personal property that has acquired a
Kentucky situs? (See 103 KAR 16:240 for definition of situs)
YES
NO
If yes, explain: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
j.
Are you a professional service provider (such as a law firm, accounting firm,
etc.) providing services in Kentucky?
YES
NO
If yes, provide dates in Kentucky: _________________________________________
________________________________________________________________________
________________________________________________________________________
11.
Do you derive income from or attributable to sources within this state
including deriving income directly or indirectly from a trust doing business
in this state?
YES
NO
If yes, provide the name, identification number and address of each:
________________________________________________________________________
________________________________________________________________________
12.
a. Do you direct activities at Kentucky customers for the purpose of selling them
tangible personal property?
YES
NO
If yes, explain: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________

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