Form 61a508 - Annual Report Of Distilled Spirits In Bonded Warehouse - 2004

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61A508 (11-04)
ANNUAL REPORT OF DISTILLED SPIRITS
IN BONDED WAREHOUSE
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
Office of Property Valuation
AS OF JANUARY 1, ________
Public Service Branch
200 Fair Oaks Lane, Fourth Floor
This return must be filed with
Station 32
the Office of Property Valua-
Frankfort, Kentucky 40620
tion between January 1 and
(502) 564-8175
February 1.
FEBRUARY 2005
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Name of Taxpayer
GNC No.
DSP No.
FEIN/SSN
Name
Billing Address
Name
Name
Address
Address
City
State
ZIP Code
Telephone No. (
)
Fax No. (
)
E-Mail
Company Contact
Name and Title
Name
Address
Address
City
State
ZIP Code
Telephone No. (
)
Fax No. (
)
E-Mail
Refer All Nonbilling Correspondence To
Name and Title
Name
Address
Address
City
State
ZIP Code
Telephone No. (
)
Fax No. (
)
E-Mail
For agents, etc., a current power of attorney must be on file with the Kentucky Department of Revenue.
I declare under penalties of perjury that this return, including any accompanying schedules and statements, has been examined
by me and to the best of my knowlege is a true, correct and complete return.
Signature
Title
Date

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