Form 10a100(P) - Kentucky Tax Registration Application
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910A100(P)(08-16)
FOR OFFICE USE ONLY
Commonwealth of Kentucky
WH
SU
TEL
CU
CT
CP
NRWH
DEPARTMENT OF REVENUE
TR
UTL
CID
LL
KENTUCKY TAX REGISTRATION APPLICATION
TF
CMRS
For faster service, apply online at
CBI #
FEIN
CRIS #
•
Incomplete or illegible applications will delay processing and will be returned.
RCS Flag
NAICS
•
See instructions for questions regarding completion of the application.
•
Need Help?
Call (502) 564-3306 or
Coded/Date Coded
Data Entry/Data Entered
Email
DOR.WEBResponseRegistration@ky.gov
SECTION A
REASON FOR COMPLETING THIS APPLICATION
(Must Be Completed)
To update information for your existing account(s) or report opening a new location of your current business,
use Form 10A104, Update or Cancellation of Kentucky Tax Account(s).
/
/
1. Effective Date
3. Previous Account Numbers
(If applicable)
Opened new business/Began activity in Kentucky
Kentucky Employer’s Withholding Tax
__________________
Kentucky Sales and Use Tax
__________________
Resumption of business
Kentucky Telecommunications Tax
__________________
Hired employees working outside KY who have a KY residence
Kentucky Utilities Gross Receipts License Tax
__________________
Applying for other accounts/Began a new taxable activity
Kentucky Consumer’s Use Tax
__________________
Bidding for state government contract (State Vendor or Affiliates)
Kentucky Corporation Income Tax and/or
Purchased an existing business (See instructions)
Limited Liability Entity Tax
__________________
Business structure change or conversion
Kentucky Coal Severance & Processing Tax
__________________
(Specify previous type; See instructions)
Kentucky Pass-Through Non-Resident Withholding __________________
Federal ID Number (FEIN)
__________________
Change of Federal Identification Number (FEIN), Kentucky
Kentucky Secretary of State Organization Number __________________
Secretary of State Organization Number, or Commonwealth
Commonwealth Business Identifier (CBI)
__________________
Business Identifier (CBI)
Other (Specify)
2.
A. Did you receive correspondence from the Division of Registration and Data Integrity requesting registration of this business?
Yes
No
B. If “Yes”, enter the File Number located at the top
File Number
of the letter you received.
SECTION B
BUSINESS / RESPONSIBLE PARTY / CONTACT INFORMATION
(Must Be Completed)
4. Legal Business Name
5. Doing Business As (DBA) Name (See instructions)
6. Federal Employer Identification Number (FEIN)
—
(Required, complete prior to submitting)
7. Kentucky Commonwealth Business Identifier
(if already assigned)
8. Secretary of State Information (if applicable)
Kentucky Secretary of State Organization Number
If you are an Out-of-State Entity, Date of
Date of Incorporation/Organization
State of Incorporation/Organization
Qualification with the Kentucky Secretary of
State’s Office
/
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/
/
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