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                                           COMMONWEALTH OF KENTUCKY
                                           DEPARTMENT OF REVENUE
                                           FRANKFORT, KENTUCKY 40620
                                             10A100(P) (11-22)

Kentucky Tax Registration Application

and Instructions

www.revenue.ky.gov

Employer’s Withholding Tax Account

Sales and Use Tax Account/Permit

Transient Room Tax Account

Motor Vehicle Tire Fee Account

Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account

Utility Gross Receipts License Tax Account

Telecommunications Tax Account

Consumer’s Use Tax Account

Corporation Income Tax Account

Limited Liability Entity Tax Account

Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account

Coal Severance and Processing Tax Account

Coal Seller/Purchaser Certificate ID Number

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10A100(P)(11-22)                                                                                              FOR OFFICE USE ONLY
Commonwealth of Kentucky                                                               WH     SU        TEL    CU           CT    CP       NRWH
DEPARTMENT OF REVENUE                                                                          TR        UTL                  CID   LL
                                                                                               TF
  KENTUCKY TAX REGISTRATION APPLICATION
                                                                                               CMRS

                                                                                     CBI #
      For faster service, apply online at
      http://onestop.ky.gov                                                          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 
              Email DOR.Registration@ky.gov                                          Coded/Date Coded                    Data Entry/Data Entered

 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               __________________
       Resumption of business                                                       Kentucky Sales and Use Tax                        __________________
       Hired employees working outside KY who have a KY residence                   Kentucky Telecommunications Tax                   __________________
      Applying for other accounts/Began a new taxable activity                      Kentucky Utilities Gross Receipts License Tax     __________________
       Bidding for state government contract (State Vendor or Affiliates)           Kentucky Consumer’s Use Tax                       __________________
       Purchased an existing business (See instructions)                           Kentucky Corporation Income Tax and/or
             Purchased business assets from previous owner                         Limited Liability Entity Tax                       __________________
                Yes       No                                                      Kentucky Coal Severance & Processing Tax           __________________
       Business structure change or conversion                                      Kentucky Pass-Through Non-Resident Withholding __________________
        (Specify previous type; See instructions)
                                                                                    Federal ID Number (FEIN)                           __________________
                                                                                    Kentucky Secretary of State Organization Number  __________________
       Change of Federal Identification Number (FEIN), Kentucky                     Commonwealth Business Identifier (CBI)            __________________
        Secretary of State Organization Number, or Commonwealth
        Business Identifier (CBI)
       Other (Specify) 
2.  A.  Did you receive correspondence from the Division of Registration requesting registration of this  business?
         Yes            No
    B.  If Yes, enter the File Number(s) located at the                  File Number                             File Number
        top 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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10A100(P)(11-22)                                                                                                                                                   Page 2

 9.  Primary Business Location                                                        11.  Accounting Period
 
     Street Address (DO NOT List a PO Box)                                                   Calendar Year:                      Year Ending  December 31st
                                                                                            
                                                                                            Fiscal Year:                        Year Ending  ___ ___ /___ ___ (mm/dd     )
                                                                                            52/53 Week Calendar Year:           _______________________________
                                                                                                                                         (Month and Day of Week Year Ends)
                                                                                            52/53 Week Fiscal Year:             _______________________________
   City                                    State         Zip  Code                                                                     (Month and Day of Week Year Ends)
  
   Telephone Number                        County (if in Kentucky)                    12. Accounting Method   
  (            )          –                                                                
                                                                                        Cash           Accrual 
                                                                                       
10.  Business Operations are Primarily
       Home Based            Web Based           Office/Store Based      Transient

13.  Business Structure
  Profit Limited Liability                Association                             General Partnership                          Public Benefit Corporation
     Company (LLC)                         Statutory Trust                        Joint Venture                                 Other (Specify)
  Non-Profit Limited Liability            Series of a Statutory Trust            Estate
     Company (LLC)
                                           Business Trust                          Government
  Professional Limited Liability
     Company (PLLC)                        Trust (Non-statutory)                   Unincorporated Non-profit
  Series of a Limited Liability           Limited Partnership (LP)                  Association
     Company                               Limited Liability Partnership          Sole Proprietorship
  Profit Corporation                      (LLP)                                   Home Care Service
  Non-Profit Corporation                  Limited Liability Limited Partnership     Recipient (HCSR)
                                           (LLLP)                                  Qualified Joint Venture
  Professional Service                                                               (Married Couple)
     Corporation (PSC)                     Series of a Partnership
  Cooperative Corporation
  Limited Cooperative 
     Association
14.  How Will You be Taxed for Federal Purposes? 
     (Sole Proprietorships, HCSRs, Qualified Joint Ventures, Estates, Governments, and Unincorporated Non-Profits SKIP question 14)
                                            Partnership                                    Single Member Disregarded Entity
                                           Corporation                                      Check below how the Member will be taxed federally 
                                           S-Corporation                                      Individual Sole Proprietorship
                                           Cooperative                                        General Partnership/Joint Venture
                                           Trust                                              Estate
                                                                                               Trust (Non-statutory)/Business Trust
                                                                                               Other (Specify how the Member is federally taxed)
15–16.  OWNERSHIP DISCLOSURE–RESPONSIBLE PARTIES (REQUIRED FOR ALL BUSINESS STRUCTURES)
                   See instructions regarding required responsible parties for your business structure
  Full Legal Name (First Middle Last)                                                   Full Legal Name (First Middle Last)

  Social Security Number (REQUIRED)        FEIN (if Responsible Party is another business)   Social Security Number (REQUIRED)   FEIN (if Responsible Party is another business)

  Driver’s License Number (if applicable)  Driver’s License State of Issuance           Driver’s License Number (if applicable)  Driver’s License State of Issuance

  Business Title                           Effective Date of Title                      Business Title                           Effective Date of Title
                                                   /           /                                                                          /           /
  Residence Address                                                                     Residence Address                                          

  City                                     State            Zip Code                    City                                     State            Zip Code
                                                                                       
  Telephone Number                         County (if in Kentucky)                      Telephone Number                         County (if in Kentucky)
  (            )                –                                                      (            )                –

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10A100(P)(11-22) Page 3
17. Person to contact about this application:
Name (First Middle Last) Title Daytime Telephone Extension
( ) –
E-mail: (By supplying your e-mail address you grant the Department of Revenue permission to contact you via e-mail.)

SECTION C TELL US ABOUT YOUR BUSINESS OR ORGANIZATION (Must Be Completed)
18a. Describe the nature of your business activity in Kentucky, including any services provided.
_________________________________________________________________________________________________________________________
18b. List products sold in Kentucky.
_________________________________________________________________________________________________________________________
The following questions will determine your need for an Employer’s Withholding Tax Account.
Yes No
19. Do you have or will you hire employees to work in Kentucky within the next six (6) months? .........................................................................  
An employee is anyone to whom you pay wages, including part-time help and family members. Kentucky corporate
officers receiving compensation other than dividends are also considered employees.
20. Do you wish to voluntarily withhold on Kentucky residents who work outside Kentucky? ...............................................................................  
21. Do you wish to voluntarily withhold on pension and retirement payments? .....................................................................................................  
22. Will your business be registered to make charitable or other lawful gaming payouts in Kentucky and be required to withhold
federal tax from those payouts? .......................................................................................................................................................................  

If you answered Yes to any of questions 19 through 22, you must complete SECTION D.
 
CONTINUE

The following questions will determine your need for a Sales and Use Tax Account,
the schedules you may need to file,
and/or your need for a
Transient Room Tax Account,
Motor Vehicle Tire Fee Account,
Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account,
Utility Gross Receipts License Tax Account, and/or
Telecommunications Tax Account.

Sales and Use Tax Account
Yes No
23. Will you make retail and/or wholesale sales of tangible or digital property in Kentucky? .................................................................................  
Examples: prepared food, internet sales, downloaded music and books. (See instructions for more.)
24. Will you install replacement parts for the repair or recondition of tangible property? .......................................................................................  
Examples: automotive repairs, computer or electronics repair, furniture repair. (See instructions for more.)
25. Will you produce, fabricate, process, print or imprint tangible property? ..........................................................................................................  
Examples: sign making, window tinting, embroidery, screen printing, engraving. (See instructions for more.)
26. Will you charge for labor or services rendered in installing or applying tangible personal property, digital property, or service sold? ...............  

CONTINUED ON NEXT PAGE

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10A100(P)(11-22) Page 4

27. Will you provide any of the following services? (See instructions for more.)

Yes No Yes No
  A. Landscaping services   AA. Condominium time-share exchange services
  B. Janitorial services   AB. Rental of space for meetings, conventions,
  C. Small animal veterinary services short-term business uses, entertainment
events, weddings, banquets, parties, and
  D. Pet care services other short-term social events
  E. Industrial laundry services   AC. Social event planning and coordination
  F. Non-coin operated laundry and dry services
cleaning services   AD. Leisure, recreational, and athletic instructional
  G. Linen supply services services
  H. Indoor skin tanning services   AE. Recreational camp tuition and fees
  I. Non-medical diet and weight reducing   AF. Personal fitness training services
services   AG. Massage services, unless medically
  J. Photography and photo finishing necessary
services   AH. Cosmetic surgery services
  K. Marketing services   AI. Body modification services that are not
  L. Telemarketing services necessary for medical or dental health,
such as tattooing, etc.
  M. Public opinion and research polling services
  AJ. Testing services, except for medical,
  N. Lobbying services educational, or veterinary reasons
  O. Executive employee recruitment services   AK. Interior decorating and design services
  P. Website design and development services   AL. Household moving services
  Q. Website hosting services   AM. Specialized design services, including the
  R. Private mailroom services (including design of clothing, costumes, fashion, furs,
presorting, bar coding, tracking delivery jewelry, shoes, textiles, and lighting
to postal service, and private mailbox rentals)   AN. Lapidary services, including cutting, polishing,
  S. Bodyguard services and engraving precious stones
  T. Residential and non-residential security   AO. Labor and services to repair or maintain
system monitoring services commercial refrigeration equipment or systems
  U. Private investigation services   AP. Labor to repair or alter apparel, footwear,
  V. Process Server Services watches, or jewelry
  W. Reposession of tangible personal property   AQ. Pre-written computer software access services
services
  X. Personal Background Check services
  Y. Parking services (including valet services and
the use of parking lots and parking structures,
excluding any parking at an educational
institution)
  Z. Road and travel services provided by
automobile clubs

CONTINUED ON NEXT PAGE

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10A100(P)(11-22) Page 5

Yes No
28. Will you sell extended warranties? ...................................................................................................................................................................  
29. Will you rent or lease tangible or digital property to others, including related companies? ..............................................................................  
30. Will you charge admissions, including initiation fees, monthly fees or membership fees for the use of a facility or participating
in an event or activity? (Non-profit organizations selling admissions other than golf admissions, check NO. (See instructions
for additional information.) ............................................................................................................................................................................  
31. Are you a remote retailer selling tangible personal property or digital property delivered or transferred electronically to a
purchaser in Kentucky? (See instructions for additional information.) .......................................................................................................  
32. Are you a manufacturer’s agent soliciting orders for a nonresident seller not registered in Kentucky? ...........................................................  
33a. Are you a marketplace provider or retailer? (See instructions for additional information.) ........................................................................  
33b. Do you facilitate sales by third party retailers? (See KRS 139.450. A marketplace provider may register for two Kentucky sales
tax account numbers. See instructions for additional information.) ...........................................................................................................  
33c. Are you applying for separate accounts for your own sales and for your facilitated sales? (See instructions for additional
information.) ...................................................................................................................................................................................................  
34. Are you a manufacturing fee processor or a contract miner operating in Kentucky? .......................................................................................  
35. Are you bidding on a contract with Kentucky state government? .....................................................................................................................  
36. Are you an affiliate of a company who has been awarded a Kentucky state government contract? ...............................................................  
37. Will you rent campsites at campgrounds or recreational vehicle parks? ..........................................................................................................  
Sales and Use Tax Account Schedules
38. Will you receive receipts from the breeding of a stallion to a mare in Kentucky? ............................................................................................  
39. Will you make sales of aviation jet fuel? ...........................................................................................................................................................  
40. Will you make sales of motor vehicles to residents of Arizona, California, Florida, Indiana, Massachusetts, Michigan, South
Carolina, or Washington? .................................................................................................................................................................................  
Transient Room Tax Account
41. Will you rent temporary lodging to others? .......................................................................................................................................................  
Examples: hotel, motel, inn, campground, or RV park (See instructions for more.)
Motor Vehicle Tire Fee Account
42. Will you sell new tires for motor vehicles or semi-trailers? ...............................................................................................................................  
Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account
43. Will you sell cellular phones with preloaded minutes, prepaid cellular phone cards, or recharge cellular phones and cards
with minutes? ...................................................................................................................................................................................................  
Utility Gross Receipts License Tax Account and/or Telecommunications Tax Account
44. Were you approved for an Energy Direct Pay Authorization with a Utility Gross Receipts License Tax Exemption? ......................................  
Attach a copy of your official UGRLT Exemption Authorization.
45. Will you sell any of the following?
Yes No Yes No
  A. Sewer services   E. Communications services
  B. Water utilities   F. Multichannel video programming services *(see instructions)
  C. Natural, artifical, or mixed gas utilities   G. Video streaming services *(see instructions)
  D. Electricity   H. Direct broadcast satellite services *(see instructions)
Yes No
46a. Will your company purchase any of the utility types listed above in question 45 B through G from
a provider outside of Kentucky? .......................................................................................................................................................................  

46b. If yes, please list the provider’s name and utility type: _____________________________________________________________________

If you answered Yes to any of questions 23 through 45 E, you must complete SECTION E.
If you answered Yes to any of questions 44 or 45 B through 45 G, you must complete SECTION F.
If you answered Yes to any of questions 45 E through 45 H, you must complete SECTION G.

 CONTINUE 

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10A100(P)(11-22) Page 6

The following question will determine your need for a Consumer’s Use Tax Account.
Skip question 47 if you must complete Section E.
Yes No
47. Will you make purchases from out-of-state vendors and not pay Kentucky Sales or Use Tax to the seller on those purchases? ..................  
If you are a PROFESSIONAL SERVICE business or if your business will make a one-time purchase only, please see
instructions for important additional details.
If you answered Yes to question 47, you must complete SECTION H.

 
CONTINUE

The following questions will determine your need for a
Corporation Income Tax Account and/or a Limited Liability Entity Tax Account.
If your answer to questions 13 and 14 was NOT
Sole Proprietorship, HCSR, Qualified Joint Venture, Estate, Government,
General Partnership taxed as a Partnership, or Joint Venture taxed as a Partnership,
you must complete questions 48 through 54.
Yes No
48. Are you organized under the laws of Kentucky with the Kentucky Secretary of State’s Office? ......................................................................  
49. Will your business have its commercial domicile in Kentucky? ........................................................................................................................  
50. Will your business own or lease any real or tangible property in Kentucky? ....................................................................................................  
51. Will your business have one or more individuals performing services in Kentucky? .......................................................................................  
52. Will your business maintain an interest in a pass-through entity or derive income from Kentucky sources? ..................................................  
53. Will you direct activities toward Kentucky customers for the purpose of selling them goods and/or services? ...............................................  
54. Will your business own/lease any intangible property or receive payments from a related member as defined in KRS 141.205(1)(g)
or an unrelated party for the use of intangible property in Kentucky such as royalties, franchise agreements, patents, trademarks,
etc.? .................................................................................................................................................................................................................  

If you answered Yes to any of questions 48 through 54, you must complete SECTION I.

 
CONTINUE

The following questions will determine your need for a
Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account.
Yes No
55. Is this business considered a pass-through entity as defined in KRS 141.010(22)? .......................................................................................  

If you answered Yes to question 55, you must answer questions 56 A and 56 B.
56. Does your pass-through entity have nonresident:
Yes No
A. Individual partner(s), shareholder(s), or member(s) receiving Kentucky distributive share income from your
pass-through entity? .................................................................................................................................................................................  
“Individual" includes estates and trusts.
B. Corporate partner(s) or member(s) receiving Kentucky distributive share income from your pass-through entity? ................................  

If you answered Yes to question 56 A and/or 56 B, you must complete SECTION J.

 CONTINUE 

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10A100(P)(11-22) Page 7

The following questions will determine your need for a
Coal Severance/Processing Tax Account and/or a Coal Seller Purchaser Certificate ID#.

Yes No
57. Will you mine coal to which you own or possess the mineral rights? ...............................................................................................................  
58. Will you purchase coal for the purpose of processing and resale, or do you process refuse coal? .................................................................  

Processing means cleaning, breaking, sizing, dust allaying, treating to prevent freezing, or loading or unloading for any purpose.
59. Will you purchase and sell coal as a coal broker? ...........................................................................................................................................  

If you answered Yes to any of questions 57 through 59, you must complete SECTION K and SECTION E.

SECTION D EMPLOYER’S WITHHOLDING TAX ACCOUNT
Must be completed if you answered Yes to any of questions 19 through 22.

60. A. Has a Kentucky Employer’s Withholding Tax Account already been assigned to this business?  Yes  No
B. If Yes, list the Employer’s Withholding Tax Account Number
61. Number of Kentucky employees ______________________________ 65. Employer’s Withholding Tax mailing address:
62. Date wages/pensions first paid or will be paid (REQUIRED)  Use the same address as your location address
 Use the same address as ______________________ Tax Account
c/o or Attn.
/ /
63 Estimated total annual tax withheld in Kentucky: Address

 $0.00–$399.99  $2,000.00–$49,999.99
City State Zip Code
 $400.00–$1,999.99  $50,000.00 or more
Mailing Telephone Number County (if in Kentucky)
( ) –
64. A. Is the withholding for your employees reported by a Common Paymaster or a Common Pay Agent?  Yes  No
Most payroll processors do NOT operate as Common Paymasters/Pay Agents. If using a payroll processor, check with them to
determine if you should answer yes to the question above.
B. If Yes, attach a separate sheet listing which you use, Common Paymaster or Common Pay Agent, and provide their Business Name, FEIN, and
Kentucky Employer’s Withholding Tax Account Number.

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10A100(P)(11-22) Page 8

SECTION E SALES AND USE TAX ACCOUNT
TRANSIENT ROOM TAX ACCOUNT
MOTOR VEHICLE TIRE FEE ACCOUNT
COMMERCIAL MOBILE RADIO SERVICE (CMRS) PREPAID SERVICE CHARGE ACCOUNT
Must be completed if you answered Yes to any of questions 23 through 45 E or any of questions 57 through 59.

66. A. Has a Kentucky Sales and Use Tax Account already been assigned to this business?  Yes  No
B. If Yes, list the Sales and Use Tax Account Number

67. Date sales began or will begin (REQUIRED) 70. Sales and Use Tax mailing address:
 Use the same address as your location address
/ /  Use the same address as _______________________ Tax Account

c/o or Attn.
68. Estimated gross monthly sales tax collected in Kentucky:
Address
 $0.00–$1,199.99  $1,200.00 or more
69. A. Does this business have additional locations in Kentucky other

than the Primary Business Location?  Yes  No City State Zip Code
B. If Yes, attach a listing of all additional Kentucky locations. For each
location, the attachment should include: doing business as (DBA) Mailing Telephone Number County (if in Kentucky)
name, physical location address, phone number, date location was ( ) –
opened, and a description of the location’s business activity.

SECTION F UTILITY GROSS RECEIPTS LICENSE TAX ACCOUNT
Must be completed if you answered Yes to any of questions 44 or 45 B through 45 G.

71. A. Has a Kentucky Utility Gross Receipts License Tax Account already been assigned to this business?  Yes  No
B. If Yes, list the Utility Gross Receipts License Tax Account Number

72. Date sales or purchases of utilities began or will begin (REQUIRED) 74. Utility Gross Receipts License Tax mailing address:
 Use the same address as your location address
/ /  Use the same address as _______________________ Tax Account

73. Telephone Number c/o or Attn.

(__________) __________ – ____________________ Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)
( ) –

Once the account for Utility Gross Receipts License Tax is assigned,
use the website below to set up account for e-file.

http://revenue.ky.gov/Business/Utility-Gross-Receipts-License-Tax/Pages/default.
aspx

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10A100(P)(11-22) Page 9

SECTION G TELECOMMUNICATIONS TAX ACCOUNT
Must be completed if you answered Yes to any of questions 45 E through 45 H.

75. A. Has a Kentucky Telecommunications Tax Account already been assigned to this business?  Yes  No
B. If Yes, list the Telecommunications Tax Account Number

76. Does your organization have tangible personal property located within the Commonwealth of Kentucky?  Yes  No

77. Select company type: 80. Telecommunications Tax mailing address:
 Use the same address as your location address
 Municipal Entity  Other Provider  Consumer  Use the same address as _______________________ Tax Account

c/o or Attn.
78. Date sales of services began or will begin in Kentucky (REQUIRED)
Address
/ /
79. Telephone Number

(__________) __________ – ____________________ City State Zip Code

Once the account for Telecommunications Tax is assigned, use Mailing Telephone Number County (if in Kentucky)
the website below to set up account for e-file. ( ) –

http://revenue.ky.gov/Business/Telecommunications-Tax/Pages/default.aspx

SECTION H CONSUMER’S USE TAX ACCOUNT
Must be completed if you answered Yes to question 47.

81. A. Has a Consumer’s Use Tax Account already been assigned to this business?  Yes  No

B. If Yes, list the Consumer’s Use Tax Account Number
82. Date purchases began or will begin (REQUIRED) 83. Consumer’s Use Tax mailing address:

 Use the same address as your location address
/ /  Use the same address as _______________________ Tax Account
c/o or Attn.

Address

City State Zip Code

Mailing Telephone Number County (if in Kentucky)
( ) –

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10A100(P)(11-22) Page 10

SECTION I CORPORATION INCOME AND/OR LIMITED LIABILITY ENTITY TAX ACCOUNT
Must be completed if you answered Yes to any of questions 48 through 54.

84. A. Has a Corporation Income and/or Limited Liability Entity Tax Account already been assigned to this business?  Yes  No
B. If Yes, list the Corporation Income or Limited Liability Entity Tax Account Number

85. A. Is this entity treated federally as a division of a parent company 89. Corporation Income and/or Limited Liability Entity Tax mailing address:
and not separately taxed as its own entity?  Yes  No
 Use the same address as your location address
B. If Yes, select the division type below:  Use the same address as _______________________ Tax Account

 Qualified Subchapter S-corporation Subsidiary (QSUB)
 Qualified Real Estate Investment Trust Subsidiary (QRS) c/o or Attn.
Address
86. If an out-of-state entity, is your Kentucky activity limited to the mere
solicitation of the sale of tangible personal property and exempt from
Corporation Income tax due to Public Law 86-272?  Yes  No
If an out-of-state entity, date activity or receipt of pass through income City State Zip Code
87.

began or will begin in Kentucky
Mailing Telephone Number County (if in Kentucky)
( ) –
/ /

88. A. Is your entity exempt from Corporation Income Tax and/or Limited Liability Entity Tax under Kentucky law?  Yes  No

B. If Yes, see Exemption Table 1 in the instructions to provide the code for your Exemption Type. __________________________________________

C. If Political Organization selected above, are you required to file federal Form 1120-POL?  Yes  No

SECTION J KENTUCKY NONRESIDENT INCOME TAX WITHHOLDING ON DISTRIBUTIVE SHARE
INCOME TAX ACCOUNT
Must be completed if you answered Yes to question 56 A and/or B.

90. A. Has a Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account already been assigned to this business?
 Yes  No
B. If Yes, list the Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account Number

91. Date first nonresident corporation or individual became a 93. Nonresident Distributive Share Withholding Tax mailing address:
partner, member, or shareholder (REQUIRED)  Use the same address as your location address
 Use the same address as _______________________ Tax Account
/ /

92. A. Is your entity exempt from Kentucky Nonresident Income Tax c/o or Attn.
Withholding on Distributive Share Income Tax under Kentucky
law?  Yes  No Address
B. If Yes, see Exemption Table 2 in the instructions to provide the
code for your Exemption Type.

__________________________________________________ City State Zip Code

Mailing Telephone Number County (if in Kentucky)
( ) –

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10A100(P)(11-22)                                                                                                                                   Page 11

   SECTION K        COAL SEVERANCE/PROCESSING TAX ACCOUNT and/or COAL SELLER/PURCHASER CERTIFICATE ID #
                                            Must be completed if you answered Yes to any of questions 56 through 58.

94.  A. Has a Coal Severance Tax Account and/or a Coal Seller/Purchaser Certificate ID # already been assigned to this business?             Yes   No
    B.  If Yes, list the Coal Severance Tax Account Number
    C.  If Yes, list the Coal Seller/Purchaser Certificate ID Number

95. Date mining/processing or coal brokering operations began       96. Coal Severance & Processing Tax mailing address: 
    or will begin (REQUIRED)                                              Use the same address as your location address
                                                                     
                                                                          Use the same address as _______________________ Tax Account
          /           /                                               c/o or Attn.
                                                                     
                                                                      Address

                                                                      City                               State         Zip Code
                                                                     
                                                                      Mailing Telephone Number           County (if in Kentucky)
                                                                     (            )                – 

                                 IMPORTANT: THIS APPLICATION MUST BE SIGNED BELOW:
The  statements  contained  in  this  application  and  any  accompanying  schedules  are  hereby  certified  to  be  correct  to  the  best  knowledge  and  belief  of  the 
undersigned who is duly authorized to sign this application.

Signature:  __________________________________________________          Printed Name: _______________________________________________

Phone Number: ______________________________________________            Title: ______________________                  Date: ____/____/______(mm/dd/yyyy)   

For assistance in completing the application, please call the Division of Registration at (502) 564–3306, Monday through Friday between the hours of 
8:00 a.m. and 5:00 p.m., Eastern Time, or you may use the Telecommunications Device for the Deaf at (502) 564-3058.

SEND completed application to:   KENTUCKY DEPARTMENT OF REVENUE 
                                 DIVISION OF REGISTRATION
                                 501 HIGH STREET, STATION 20
                                 FRANKFORT, KENTUCKY 40602-0299

                                 FAX:       502–227–0772
                                 E-MAIL:    DOR.Registration@ky.gov
If you would like to register for Electronic Funds Transfer (EFT), visit the Kentucky Department of Revenue website at http://revenue.ky.gov .

This form does not include registration with the Secretary of State, Unemployment Insurance, or Workers’ Compensation Insurance. For assistance, 
please contact those offices at the telephone numbers below. 

Secretary of State      (502) 564–3490      Unemployment Insurance  (502) 564–2272                       Workers’ Compensation                (502) 564–5550
IRS—FEIN                (800) 829–4933 

For assistance with other questions about starting a business in Kentucky, including special licensing and permitting requirements, business structure registration, 
employer responsibilities, and business development resources, call the Business Information Clearinghouse at 1–800–626–2250 or visit the Kentucky Business 
One Stop website at http://onestop.ky.gov . 

                                            The Kentucky Department of Revenue does not discriminate on the basis of race, color, national origin, 
                                            sex, age, religion, disability, sexual orientation, gender identity, veteran status, genetic information or 
                                            ancestry in employment or the provision of services.

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INSTRUCTIONS

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10A100(P)(11-22) INSTRUCTIONS
Commonwealth of Kentucky
DEPARTMENT OF REVENUE KENTUCKY TAX REGISTRATION APPLICATION

WHAT IS THE PURPOSE OF THE KENTUCKY TAX REGISTRATION APPLICATION?
This application is used to apply for any of the following: Employer’s Withholding Tax Account, Sales and Use Tax Account/Permit,Transient Room Tax Account,
Motor Vehicle Tire Fee Account, Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account, Telecommunications Tax Account, Utility Gross
Receipts License Tax Account, Consumer’s Use Tax Account, Corporation Income Tax Account, Limited Liability Entity Tax Account, Kentucky Nonresident Income
Tax Withholding on Distributive Share Income Tax Account, Coal Severance and Processing Tax Account, and/or Coal Seller/Purchaser Certificate ID Number.
DO I HAVE ANY OTHER DEPARTMENT OF REVENUE TAX REGISTRATION REQUIREMENTS?
Depending on the product or service your business provides, there may be other state taxes that apply to your business. Most of these require that you file a
special application/registration. To register for Tobacco Tax, Minerals or Natural Gas Severance Tax, Motor Fuels Tax, or any other miscellaneous taxes
or fees administered by the Department of Revenue, visit the Department’s website at www.revenue.ky.gov .
I ALREADY HAVE TAX ACCOUNTS, HOW DO I UPDATE MY ACCOUNT INFORMATION?
Complete FORM 10A104, UPDATE OR CANCELLATION OF KENTUCKY TAX ACCOUNT(S), to update information; such as business name, location or mailing
addresses, phone numbers, accounting period, responsible party information, and to report a taxing election change with the Internal Revenue Service (IRS) or
to request cancellation of your accounts. Visit www.revenue.ky.gov to obtain the form.
You may also update certain business and tax account information for the Department of Revenue and the Kentucky Secretary of State’s Office online. If you do
not already have online access to your business, follow the steps below.
1. Go to onestop.ky.gov .
2. Click on the link for One Stop Business Services.

Note: The One Stop Business Services login page provides information on creating a user account, as well as portal security. You will also find overview
information for the services the portal currently provides. This information is updated regularly to reflect new services and notify you when additional agencies
join the portal.
3. Welcome to the Kentucky Online Gateway. Select that you are a citizen or business partner and click Create Account.
4. Complete your Kentucky Online Gateway user account. Once a user account has been created, an e-mail will be sent to you with further instructions to
activate the account and login. You must use the activation link in the e-mail prior to logging in to your account.
5. Once logged in, launch the Kentucky Business One Stop App.
6. Go to the Link My Business option. Click on the link provided within that webpage to obtain the Commonwealth Business Identifier (CBI) and the Security
Token for the business.
Note: You will be able to provide information to gain immediate access to the business or request a letter be mailed, which contains your CBI and Security
Token. To gain secure access to the portal, each business has been assigned a unique Security Token, which is an enhanced security feature of the portal.
7. Once you have the CBI and Security Token for the business, the Link My Business option will require you to name at least one “One-Stop Portal Business
Administrator.” (This should be the business owner or a representative from the business.)
Note: The administrator can then delegate access to other individuals—for example, an attorney, accountant or manager. The administrator also determines
the appropriate authority level for delegates to make changes—this could include changes such as filing annual reports with the Secretary of State’s Office,
changing the business address, or filing and paying taxes. Only the One Stop business administrator(s) can grant, approve, withdraw or revoke access to
the business.
For more information about registering and using the portal, visit onestop.ky.gov . For questions, please call the Kentucky Business One Stop Help Line at
(502) 564-5053.
WHO CAN I CALL WITH QUESTIONS ABOUT REGISTRATION?
For help completing the application, please call the Division of Registration at (502) 564-3306, Monday through Friday between the hours of 8:00
a.m. and 5:00 p.m., Eastern Time.
You may also use the Telecommunications Device for the Deaf, (502) 564-3058.
The Department of Revenue has an Ombudsman who serves as your advocate and is available to make sure your rights are protected. You may contact the
Ombudsman at (502) 564-7822.
WHEN SHOULD I FILE MY APPLICATION?
You are required to complete the application and file it with the Kentucky Department of Revenue at least 30 days before engaging in an activity that requires
the establishment of the following:
n Employer’s Withholding Tax Account (KRS 141.310) n Consumer’s Use Tax Account (KRS 139.310)
n Sales and Use Tax Account (KRS 139.200, 139.240) n Utility Gross Receipts License Tax Account (KRS 160.613)
n Transient Room Tax Account (KRS 142.400) n Telecommunications Tax Account (KRS 136.614 and 136.616)
n Motor Vehicle Tire Fee Account (KRS 224.50-868) n Coal Seller/Purchaser Certificate ID Number (KRS 143.037)
n Commercial Mobile Radio Service Prepaid Service Charge Account (KRS 65.7634)

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10A100(P)(11-22)                                                                                                                                  Page 2
Pass-Through Entities must complete the application to establish a Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account 
(KRS 141.206) within 30 days of obtaining a Kentucky non-resident individual or corporate partner, member, or shareholder.
Corporations and Limited Liability Entities must complete the application to establish a Corporation Income Tax Account and/or a Limited Liability Entity Tax 
Account (KRS 141.040, 141.0401):

   If you are...                                                            Then your application should be filed...

   Kentucky formed                                                          Within 30 days of formation with the Kentucky Secretary of State’s Office

   Formed out-of-state and you have obtained a Certificate of Authority to  Within 30 days of obtaining a certificate of authority, provided that you
   transact business in Kentucky from the Kentucky Secretary of State       are treated as doing business in Kentucky under KRS Chapter 141
   Formed out-of-state and you have NOT obtained a Certificate of Authority Within 30 days  of first engaging in activities that result in you being 
   to transact business in Kentucky from the Kentucky Secretary of State    treated as doing business in Kentucky under KRS Chapter 141

IS MY APPLICATION COMPLETE?
Your application will not be considered complete unless it includes all required information specified on the form. This includes, but is not limited to, a Federal 
Employer Identification Number and accurate Social Security Number(s), as appropriate. You are required to provide your Social Security Number on tax forms 
per Section 405, Title 42, of the United States Code. This information will be used to establish your identity for tax purposes. 
WHAT PENALTIES APPLY?
Failure  to  complete  and  file  the  required  application  in  the  specified  time  frames  listed  above  shall  subject  you  to  applicable  penalties  as  provided  in
KRS 131.180.
HOW LONG WILL IT TAKE FOR MY ACCOUNT NUMBERS TO BE ASSIGNED?
Fully completed paper applications will be processed, barring seasonal workload increases, within 5 to 10 business days. Applications with missing or unclear 
information requiring additional research may take longer. Those with extensive amounts of missing information will be returned by mail for further completion.
For faster service, apply online at onestop.ky.gov .
Note: If your business structure is not available as a selection online, you must submit a completed Kentucky Tax Registration Application by mail, fax, or e-mail. 

LINE BY LINE APPLICATION INSTRUCTIONS
SECTION A—REASON FOR COMPLETING THIS APPLICATION
1. Effective Date—Enter the effective date of the reason you are completing this application. Check the box which corresponds to why the application is 
   being completed.
   •  Opened New Business, Began Activity in Kentucky, Resumption of Business, Hired Employees Working Outside Kentucky Who Have a 
      Kentucky Residence—Complete Sections A, B, and C to determine the accounts for which you are required to apply. For Resumption of Business, list 
      your previous account numbers in Section A, question 3.
   •  Applying for Other Accounts, Began a New Taxable Activity—If you require an account type that is not currently assigned to your business, complete 
      Sections A, B, and C to determine the additional accounts for which you are required to apply.  If the questions in Section C lead you to complete a 
      Section for an account type you already have, write your current account number in the field provided within the Section you are completing.
   •  Bidding for State Government Contract (State Vendor or Affiliates)—Any vendor who contracts to sell, install, or provide services to the Commonwealth 
      of Kentucky or one of its agencies, or any affiliate of a company who contracts to sell, install, or provide services to the Commonwealth, is required to 
      register for Kentucky Sales and Use Tax per KRS Chapter 45A, and collect and remit the Sales and Use Tax imposed by KRS Chapter 139. Complete 
      Sections A, B, and C to determine the accounts for which you are required to apply.
   •  Purchased an Existing Business—(This will include a business previously owned by a family member.)

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10A100(P)(11-22)                                                                                                                                  Page 3

   If the business you purchased was a...                              Then...
   n  Sole Proprietorship
   n  Joint Venture
   n  Qualified Joint Venture
   n  General Partnership
   n  Series of a Statutory Trust                                     You will need to apply for new accounts. List the previous owner’s 
   n  Limited Partnership (LP)                                        accounts in Section A, question 3, and complete Sections B and C to 
   n  Limited Liability Partnership (LLP)                             determine the account(s) for which you are required to re-apply. 
   n  Limited Liability Limited Partnership (LLLP)
   n  Series of a Partnership
   n  Series of a Limited Liability Company (LLC) 
   n  Protected Cell Company (PCC)

   n  Profit Corporation                                              If:
   n  Profit Limited Liability Company (LLC)                                 –you are converting the purchased business to a new business structure, 
   n  Professional Service Corporation (PSC)                                 or
   n  Professional Limited Liability Company (PLLC)                          –the Federal Identification Number (FEIN) has changed, or 
   n  Public Benefit Corporation                                             –the Secretary of State Organization Number has changed, or
   n  Association                                                            –the Commonwealth Business Identifier (CBI) has changed,
   n  Cooperative Corporation
   n  Limited Cooperative Association                                 you will need to apply for new accounts. List the previous owner’s 
   n  Statutory Trust                                                 accounts in Section A, question 3, and complete Sections B and C to 
   n  Business Trust                                                  determine the account(s) for which you are required to re-apply. 
   n  Trust (non-statutory)
   n  Non-Profit Corporation                                          If the business structure, Federal Identification Number (FEIN), Secretary 
   n  Non-Profit Limited Liability Company (LLC)                      of State Organization Number, and Commonwealth Business Identifier 
   n  Unincorporated Non-Profit Association                           (CBI) will all stay the same, DO NOT use the Kentucky Tax Registration 
                                                                      Application.  Use  Form  10A104,  Update  or  Cancellation  of  Kentucky 
                                                                      Tax Account(s), to provide the updated business and responsible party 
                                                                      information or update your information online. 

Note to persons buying a business: Any person buying a business may incur a sales tax liability on the purchase of the business assets or become personally 
liable for the prior sales tax liability of the seller. It may be necessary for the purchaser to withhold a part of the sales price until verification has been furnished 
by the seller that tax liabilities have been paid or do not exist. Therefore, it is important that anyone purchasing a business obtain a copy of Kentucky Revised 
Statutes 139.670 and 139.680 to determine the tax consequences and potential liability in such transactions. Copies are available at www.revenue.ky.gov, by 
writing the Office of Sales and Excise Taxes, Department of Revenue, P. O. Box 1274, Frankfort, Kentucky 40602-1274, or by calling (502) 564-5170.
   • Business Structure Change or Conversion, Change in Federal Identification Number (FEIN), Change in Kentucky Secretary of State Organization 
     Number, or Change in Commonwealth Business Identifier (CBI)—A business may change its taxing election with the Internal Revenue Service 
     (IRS) and retain the same Kentucky tax account numbers. However, any change to an entity’s business structure, Federal Identification Number (FEIN), 
     Kentucky Secretary of State Organization Number, or Commonwealth Business Identifier (CBI) requires that new accounts be applied for with the 
     Department of Revenue.
     To change a taxing election, use Form 10A104, Update or Cancellation of Kentucky Tax Account(s), to provide the updated business and responsible 
     party information.
     For all other business structure changes or conversions, for receiving a new Federal Identification Number (FEIN), for receiving a new Kentucky 
     Secretary of State Organization Number, or for receiving a new Commonwealth Business Identifier (CBI), you must apply for new Kentucky tax 
     account numbers. List your old account numbers in Section A, question 3, and complete Sections A, B and C to determine the account(s) for which 
     you are required to re-apply.
     Examples of conversions requiring a business apply for new accounts are:
    n  A Sole Proprietorship converting to a General Partnership and vice versa,
    n  A Corporation converting to a Limited Liability Company (LLC) and vice versa,
    n  A Limited Liability Company (LLC) converting to a Statutory Trust and vice versa, or
    n  Any ownership type converting to a Limited Liability Company (LLC) and vice versa.
2.  Did you receive correspondence from the Division of Registration and Data Integrity—If you received a letter(s) requesting registration, check Yes and 
   list the File Number(s) from the letter in B. If No, leave B blank.
3.  Previous Kentucky Account Numbers—If you have purchased an existing business, list the previous owner’s accounts, if available. If your current business 
   has changed business structures, received a new Federal Identification Number (FEIN), received a new Kentucky Secretary of State Organization Number, or 
   a new Commonwealth Business Identifier (CBI) and your company must apply for new accounts or you have resumed an old business, list your old accounts 
   in Section A, question 3. A request in writing from the previous owner is required to cancel previous accounts.
SECTION B—BUSINESS / RESPONSIBLE PARTY / CONTACT INFORMATION
4. Legal Business Name—Enter the complete legal business name for your business or organization.
   Note: If the business is a Sole Proprietorship, do not include your personal name unless it is a part of the business name or you do not have a business 
   name. For example: John Smith’s Plumbing.
   If the business is a Home Care Service Recipient (HCSR), the name of the business should be the first, middle and last name of the disabled or elderly 
   individual with the acronym “HCSR” added to the end of the name. For example: “John Q Public HCSR”.
5. Doing Business As (DBA)—If your business or organization has a “doing business as” name, enter the name.
6. Federal Employer Identification Number (FEIN)—Enter the FEIN assigned to your business or organization by the Internal Revenue Service. If you are a 
   disregarded entity that is operating under your parent’s FEIN, DO NOT list your parent’s/member’s FEIN.

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10A100(P)(11-22) Page 4
Apply for a FEIN online at www.irs.gov or contact the IRS at (800) 829-4933. Sole Proprietorships and Disregarded Entities that do not have employees or
file certain federal excise tax returns may not be required to hold a FEIN for federal purposes. However, all businesses applying for Kentucky tax accounts
are encouraged to obtain a FEIN. A FEIN helps distinguish a business from others with similar names, and for certain documents, may be an alternative to
using a personal Social Security Number.
7. Kentucky Commonwealth Business Identifier (CBI)—If your business has already been assigned a CBI, enter that 10-digit number. This number is used
to uniquely identify your business for the Kentucky One Stop Portal across all state agencies that utilize the portal.
8. Secretary of State Information—Sole Proprietorships, Estates, HCSRs, Governments, Unincorporated Non-Profit Associations, Unincorporated Associations,
Qualified Joint Ventures, and Non-statutory Trusts are not required to register with the Kentucky Secretary of State. General Partnerships or Joint Ventures
who do not operate using a DBA or Assumed Name are not required to register with the Kentucky Secretary of State.
For all remaining entities, enter the Organization Number assigned to your entity by the Kentucky Secretary of State’s Office. Enter your date of incorporation/
organization and list the state in which you incorporated/organized. If an out-of-state entity, list the date you qualified with the Kentucky Secretary of State’s
Office to do business in Kentucky.
9. Primary Business Location—List the street address, city, state and ZIP Code for the location for which you are requesting registration. Do not list a P.O.
Box for a business location address. For out-of-state businesses that do not have a Kentucky location, use the principal location address in your home state.
If your location is in Kentucky, enter county name. If out-of-state, leave county blank. Enter the telephone number for the listed location; include the area
code.
10. Business Operations are Primarily—Check the box where your business is primarily operated.
11. Accounting Period—Check the box that corresponds to when your business or organization’s accounting period ends. If you choose the fiscal year filing
box, enter the month and day when your year ends. If you choose the 52/53 week calendar year box, enter the month and day of the week your year ends.
If you choose the 52/53 week fiscal year box, enter the month and day of the week your year ends.
Note: Most businesses operate under a calendar year basis (year end December 31).
12. Accounting Method—Check the box corresponding to the accounting method your company uses.
Cash Basis—The business elects to report receipts in the accounting period that payment is actually or constructively received from the customer, even
though the customer may take posession of the product before actually paying for it.
Accrual Basis—The business elects to report receipts in the accounting period that the sale actually occurs, regardless of when the customer makes payment
for such purchases.
13. Business Structure—Check the box for the organizational structure type you have selected for your business. If “Other” selected, enter the structure type
on the blank provided.

Business Structure Basic Definition

Profit Limited Liability Company (LLC) An organization of individuals chartered by law and operating under the direction of members or managers.
For US federal taxation purposes an LLC can be taxed as a single member disregarded entity, partnership,
Non-Profit Limited Liability Company or a corporation.
(LLC)
A Non-Profit LLC is a special type of LLC formed for educational, charitable, social, religious, civic or
Professional Limited Liability Company humanitarian purposes.
(PLLC)
A PLLC is a special type of LLC formed to engage in specific types of licensed professional services such
Series of a Limited Liability Company as law, medicine, architecture, accounting, engineering, etc.
Some states’ laws allow for the formation of Series underneath a main or master LLC, which has separate
rights, powers, or duties, or has a separate purpose or investment objective.
Each LLC which has a Series should register each of its separate Series which do business in Kentucky
with the Kentucky Secretary of State’s Office as an assumed name.
For Kentucky Department of Revenue purposes, each Series within an LLC must register for its own
separate Corporation Income Tax and/or Limited Liability Entity Tax Account, unless it has chosen a
disregarded status.

Profit Corporation An organization chartered by law and recognized as having a legal existence as an entity separate from
its owners. It operates under the direction of duly elected officers.
Non-Profit Corporation
A Non-Profit Corporation is a special type of corporation formed for educational, charitable, social, religious,
Professional Service Corporation (PSC) civic, or humanitarian purposes.
Public Benefit Corporation A PSC is a special type of corporation formed to engage in specific types of licensed professional services
such as law, medicine, architecture, accounting, engineering, etc.
A Public Benefit Corporation is a special type of corporation created to perform a specific function for the
benefit of the public.

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10A100(P)(11-22)                                                                                                                       Page 5

Business Structure                   Basic Definition

Cooperative Corporation              A group of individuals known as patrons who have supplied their own capital at their own risk, who 
                                     democratically direct and manage the enterprise, and who themselves receive the fruits of their 
Limited Cooperative Association      cooperative endeavors, through the allocation of the excess among themselves. In general, Cooperatives 
                                     are treated as corporations for Kentucky tax purposes.

                                     Limited Cooperative Associations must register as such with the Kentucky Secretary of State’s Office. This 
                                     business structure allows for investor members in addition to patron members. For Kentucky purposes, 
                                     Limited Cooperative Associations are also subject to the Limited Liability Entity Tax.

Association                          An association is an unincorporated group joined together for a common purpose. However, associations 
                                     may be treated as corporations for Kentucky tax purposes.

Trust (Non-statutory)                A legal entity that acts as fiduciary, agent or trustee on behalf of a person or business entity for the purpose 
                                     of administration, management and the eventual transfer of assets to a beneficial party.
Business Trust
                                     A Statutory Trust must register as such with the Kentucky Secretary of State’s Office.
Statutory Trust
                                     A Series of a Statutory Trust is a Series established by a Statutory Trust, which has separate rights, powers, 
Series of a Statutory Trust          or duties, or has a separate purpose or investment objective. Each Statutory Trust should register each of 
                                     its separate Series with the Kentucky Secretary of State’s Office as an assumed name. (KRS 386A.4-010)
                                     For Kentucky purposes, Statutory Trusts and Series of Statutory Trusts are subject to the Limited Liability 
                                     Entity Tax.
                                     For Kentucky Department of Revenue purposes, each Series within a Statutory Trust must register for its 
                                     own separate Limited Liability Entity Tax Account, unless it has chosen a disregarded status.

Limited Partnership (LP)             A partnership formed by two or more persons having one or more general partners and one or more 
                                     limited partners. The limited partner(s) have restricted liability for the business debts, while the general 
Limited Liability Partnership (LLP)  partner(s) are fully liable. Limited liability will only be recognized for partnerships registered as a limited 
                                     partnership through a state’s Secretary of State’s Office.
Limited Liability Limited Partnership
(LLLP)                               Some states’ laws allow for the formation of Series underneath the main or master Partnership, which 
                                     has separate rights, powers, or duties, or has a separate purpose or investment objective.
Series of a Partnership
                                     Each Partnership which has a Series should register each of its separate Series which do business in 
                                     Kentucky with the Kentucky Secretary of State’s Office as an assumed name.
                                     For Kentucky Department of Revenue purposes, each Series within a Partnership must register for its 
                                     own separate Limited Liability Entity Tax Account, unless it has chosen a disregarded status.

General Partnership                  Two or more individuals owning and/or operating a business. All partners jointly share profits and losses 
                                     and are individually responsible for debts incurred.

Joint Venture                        A business entity that is generally short lived, frequently common to construction related activities, 
                                     where two or more individuals or businesses come together temporarily to participate in a profit making 
                                     activity. Usually, each partner specializes in a specific field of expertise or has resources not available 
                                     to the other partner(s).

Estate                               The total property, real and personal, that was owned by an individual, now deceased, before distribution 
                                     through a trust or will.

Government                           City, county, state, and federal agencies.

                                     An unincorporated informal group of members who come together to perform some social good conducted 
Unincorporated Non-Profit            for nonprofit purposes. Per KRS 273A.005(6), “Nonprofit purposes” means any one (1) or more of 
Association                          the following purposes: charitable, benevolent eleemosynary, educational, civic, patriotic, political, 
                                     governmental, religious, social, recreational, fraternal, literary, cultural, athletic, scientific, agricultural, 
                                     horticultural, animal husbandry, and professional commercial, industrial, or trade association, but shall 
                                     not include labor unions, cooperative organizations, and organizations subject to any of the provisions 
                                     of the insurance laws or banking laws of this state which may not be organized under this chapter.

Sole Proprietorship                  One single person owning and/or operating a business, solely responsible for all debts and liabilities 
                                     incurred by the business.

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Business Structure Basic Definition

Home Care Service Recipient (HCSR) A disabled or elderly individual participating in an in-home domestic services program administered by
a state or local agency where all or part of the services received are paid for with funds supplied by the
federal, state, or local government.
A Federal Identification Number (FEIN) is issued in the name of the disabled or elderly individual (Service
Recipient) as the employer. The Service Recipient or their family designates an agent to report, file, and
pay employment taxes on the Service Recipient’s behalf.

Qualified Joint Venture A business jointly owned and operated by a married couple who are electing to have the business not
treated as a general partnership for federal tax purposes. Spouses electing qualified joint venture status
are treated as sole proprietors for federal tax purposes.

Other Any ownership not elsewhere classified.

14. How will You be Taxed for Federal Purposes? Indicate how this business will be treated for federal purposes. If “Single Member Disregarded Entity, Other”
is selected, list what type of entity the single member is and how it is taxed.
15-16. Ownership Disclosure—Responsible Parties—Enter the full legal name, Social Security Number (required if responsible party is an individual), FEIN
(if responsible party is another business), driver’s license number, driver’s license state of issuance, residence address, city, state, ZIP Code, telephone
number, county (if in Kentucky), business title and the date for when the title became effective for the information that corresponds to your business structure.
Note: Social Security Numbers for responsible parties are required (KRS 131.180(3)). Also, you are required to provide your Social Security Number
on tax forms per Section 405, Title 42, of the United States Code. This information will be used to establish your identity for tax purposes.

If your Business Structure is... Then the required Ownership/Responsible Party disclosure is...

n Sole Proprietorship Enter owner’s individual information, including Social Security Number, in
n Profit Limited Liability Company (LLC) for Federal Purposes Taxed as question 15.
an Individual Sole Proprietorship
n Professional Limited Liability Company (PLLC) for Federal Purposes Do not use name abbreviations or nicknames.
Taxed as an Individual Sole Proprietorship
n Non-Profit Limited Liability Company (LLC) for Federal Purposes
Taxed as an Individual Sole Proprietorship

n Qualified Joint Venture Enter the information for the married couple, including Social Security
Numbers, in question 15 and 16.
Do not use name abbreviations or nicknames.

n Profit Limited Liability Company (LLC) for Federal Purposes Taxed as Enter the single member’s company information, including FEIN, in question
a Single Member Disregarded Entity 15.
n Professional Limited Liability Company (PLLC) for Federal Purposes
Taxed as a Single Member Disregarded Entity If the LLC has managers, their full individual information can be entered in
n Non-Profit Limited Liability Company (LLC) for Federal Purposes question 16. Attach a separate sheet for more LLC managers.
Taxed as a Single Member Disregarded Entity
n Profit Corporation Enter the officers’ information, including Social Security Numbers in
n Professional Service Corporation (PSC) questions 15 and 16. If more than two officers, attach a separate sheet.
n Public Benefit Corporation
n Association Note: Information for the President is required. The information for an Officer
n Cooperative Corporation must be for an individual and not another business.
n Limited Cooperative Association
n Non-Profit Corporation
n Government
n Unincorporated Non-Profit Association Enter the members’/managers’ information in questions 15 and 16. If
members/managers are individuals, provide their Social Security Numbers.
If members/managers are other businesses, provide their FEINs.
If more than two members/managers, attach a separate sheet.

n Statutory Trust Enter the trustee information in questions 15 and 16. If trustees are
n Series of a Statutory Trust individuals, provide their Social Security Numbers. If trustees are other
n Business Trust businesses, provide their FEINs. If more than two trustees, attach a
n Trust (non-statutory) separate sheet.
For a Series of a Statutory Trust, also provide the information for the master
Statutory Trust under which it was formed, including the FEIN for the master
Statutory Trust.

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10A100(P)(11-22) Page 7

If your Business Structure is... Then the required Ownership/Responsible Party disclosure is...

n Joint Venture Enter the partners’/members’ information in questions 15 and 16. If partners/
n General Partnership members are individuals, provide their Social Security Numbers. If partners/
n Limited Partnership (LP) members are other businesses, provide their FEINs.
n Limited Liability Partnership (LLP)
n Limited Liability Limited Partnership (LLLP) If more than two partners/members, attach a separate sheet.
n Limited Liability Company (LLC) for Federal Purposes Taxed as Other
Than Disregarded Note: For any entity taxed as a partnership at least two partners/members
n Professional Limited Liability Company (PLLC) for Federal Purposes must be listed.
Taxed as Other Than Disregarded
n Non-Profit Limited Liability Company (LLC) for Federal Purposes
Taxed as Other Than Disregarded

n Series of a Partnership Enter the information for the master Partnership or master Limited Liability
n Series of a Limited Liability Company Company, including FEIN, in question 15.
If the Series of the LLC has managers, their full individual information can
be entered in question 16. Attach a separate sheet for more LLC managers
of the Series.

n Estate Enter the information for the estate administrator, including Social Security
Number, in question 15.

n Home Care Service Recipient (HCSR) Enter the information, including FEIN, for the agent that has been designated
to report, file, and pay employment taxes on the Service Recipient’s behalf
in question 15. The business title for the agent should be listed as “HCSR
Agent”.
HCSR Agents are not liable for debts of the HCSR business and are
processing agents only.

17. Person to contact about this application— Enter the name, title, daytime telephone number, extension, and e-mail address for the person to contact with
questions about this application.

SECTION C—TELL US ABOUT YOUR BUSINESS OR ORGANIZATION—Answer questions 18 through 58 to determine accounts for which your business
or organization is required to apply.
18a. Business Activity Description—Give a description of the nature of your Kentucky business activity, including a description of any services provided.
18b. Products Sold in Kentucky—List any products sold in Kentucky.
19. An employee is anyone to whom you pay wages, including part-time help and family members (KRS 141.010, 103 KAR 18:010 and 103 KAR 18:070).
Kentucky corporate officers who receive compensation, other than dividends, are legally considered employees for withholding purposes (KRS 141.010).
20. Kentucky withholding is not required from wages of Kentucky residents that work entirely outside the state, but your business may choose to voluntarily
register to withhold.
21. Kentucky withholding is not required from payments of pensions/retirements, but your business may choose to voluntarily register to withhold.
22. If your business is required to withhold federal tax on gaming payouts made to Kentucky residents, then it will also be required to withhold Kentucky tax.
The business is required to obtain an Employer’s Withholding Tax Account for reporting and paying the Kentucky withholding.
23. All businesses or organizations making regular and continuous sales of Tangible Property or Digital Property within Kentucky, including those via Internet
and at flea markets or antique malls, are required to register for a Sales and Use Tax Account.
Tangible Personal Property (KRS 139.010(41)) “means personal property which may be seen, weighed, measured, felt or touched, or which is in any
way or manner perceptible to the senses, and includes natural, artificial, and mixed gas, electricity, water, steam, and prewritten computer software.”
Digital Property (KRS 139.010(10)) “means any of the following which is transferred electronically: digital audio works, digital books, finished artwork,
digital photographs, periodicals, newspapers, magazines, video greeting cards, audio greeting cards, video games, electronic games, or any digital code
related to this property. Digital Property does not include audio-visual works or satellite radio programming.”

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10A100(P)(11-22)                                                                                                                          Page 8
24.  A repairer or reconditioner of tangible property is a retailer of parts and materials furnished in connection with repair work and as such must collect Sales 
     and Use Tax (103 KAR 27:150). 
25.  Charges, including labor charges, for producing, fabricating, processing, printing, or imprinting tangible property are subject to Sales and Use Tax (103 KAR 
     27:130 and 103 KAR 28:030).
26.  Beginning July 1, 2018, the amount charged for labor or services rendered in installing or applying the tangible personal property, digital property, or service 
     sold is subject to Sales and Use Tax (KRS 139.010(15)(a)(6)).
27a. Beginning July 1, 2018, the collection of Sales and Use Tax is required on the following services (KRS 139.200(2)(g-p)).

Landscaping services, including but not limited to:                           Non-coin operated laundry and dry cleaning services
n  Lawn care and maintenance services
n  Tree trimming, pruning or removal services
n  Landscape design and installation services
n  Landscape care and maintenance services
n  Snow plowing or removal services

Janitorial services, including but not limited to:                            Linen supply services, including but not limited to: 
n  Residential and commercial cleaning services                               n  Table and bed linen supply services
n  Carpet, upholstery, and window cleaning services                           n  Non-industrial uniform supply services

Small animal veterinary services, excluding veterinary services for equine,   Indoor skin tanning services, including but not limited to: 
cattle, poultry, swine, sheep, goats, llamas, alpacas, ratite birds, buffalo, n  Tanning booth or tanning bed services
and cervids.                                                                  n  Spray tanning services

Pet care services, including but not limited to:                              Non-medical diet and weight reducing services
n  Grooming and boarding services
n  Pet sitting services
n  Pet obedience or training services

Industrial laundry services, including but not limited to: 
n  Industrial uniform supply services
n  Protective apparel supply services
n  Industrial mat and rug supply services

27b. Beginning January 1, 2023, the collection of Sales and Use Tax is required on the following services (KRS 139.200 (2) (q) – (ay)).

Photography and photo finishing services                                      Private mailroom services
n  Taking, developing, or printing of an original photograph                  n  Presorting mail and packages by postal code
n  Image editing, composite image creation, formatting, watermarking          n  Address bar coding
     printing, and delivery of an original photograph in the form of tangible n  Tracking
     personal property, digital property, or other media                      n  Delivery to postal services
n    Excludes services necessary for medical or dental health                 n  Private mailbox rentals

Marketing services                                                            Social event planning and coordination services
n  Developing marketing objectives and policies, sales forecasting, new 
     product developing and pricing, licensing, and franchise planning

Telemarketing services                                                        Rental of space for meetings, conventions, short-term business uses, 
n  Services provided via telephone, facsimile, electronic mail, or other      entertainment events, weddings, banquets, parties, and other short-term 
     modes of communications to another person, which are unsolicited by      social events
     that person, for the purposes of promoting products or services, taking 
     orders, providing information or assistance regarding the products or 
     services, or soliciting contributions

Public opinion and research polling services                                  Leisure, recreational and athletic instructional services

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10A100(P)(11-22)                                                                                                                                   Page 9

 Lobbying services                                                               Recreational camp tuition and fees

 Executive employee recruitment services                                         Personal fitness training services

 Website design and development services                                         Massage services, unless medically necessary

 Web site hosting services                                                       Bodyguard services

 Residential and non-residential security system monitory services               Private investigation services

 Process Server Services                                                         Testing services, except for medical, educational, or veterinary reasons

 Repossession of tangible personal property services                             Interior decorating and design services

 Household moving services                                                       Personal Background check services

 Road and travel services provided by automobile services                        Labor and services to repair or maintain commercial refrigeration services

 Labor to repair or alter apparel, footwear, watches, or jewelry                 Condominium time-share exchange services

 Specialized design services, including                                          Lapidary services, including
 n  The design of clothing, costumes, fashion, furs, jewelry, shoes, textiles,   n  Cutting, polishing, and engraving precious stones
    and lighting
 Parking services                                                                Body modification services, including
 n  Valet services                                                               n  Tattooing, piercing, scarification, branding, tongue splitting, transdermal 
 n  The use of parking lots and parking structures                                and subdermal implants, ear pointing, teeth pointing, and any other 
 n  Excludes any parking services at an educational institution                   modifications that are not necessary for medical or dental health

 Cosmetic surgery services                                                       Prewritten computer software access services
 n  Modifications  to  all  areas  of  the  head,  neck,  and  body  to  enhance n  Services for the right of access to prewritten computer software where 
    appearance through surgical and medical techniques                            the object of the transaction is to use the prewritten computer software 
 n  Excludes reconstruction of facial and body defects due to birth disorders,    while possession of the prewritten computer software is maintained by the 
    trauma, burns, or disease                                                     seller or a third party, wherever located, regardless of whether the charge 
                                                                                  of the access or use is on a per use, per user, per license, subscription, 
                                                                                  or some other basis

28. Beginning July 1, 2018, the sale of an extended warranty on tangible or digital property is subject to Sales and Use Tax (KRS 139.200((2)(q)). 
    Beginning July 1, 2019, extended warranty services do not include the sale of a service contract agreement for tangible personal property to be used by a 
    small telephone utility or a Tier III CMRS provider (KRS 139.010(13)(b)).
    Beginning January 1, 2023, the definition for extended warranty services includes extended warranty contracts for real property and all extended warranty 
    contracts for tangible personal property and digital property regardless of whether the property itself is taxable or exempt.
29. Rental of tangible property or digital property is a taxable activity. Additionally, if you have formed a separate business to hold title to equipment, machinery, or 
    other tangible property or digital property for lease back to another business you own, you will be required to charge Sales and Use Tax on those transactions 
    (103 KAR 28:051).
30. Beginning July 1, 2018, admissions paid for the right of entrance to an entertainment or amusement event or venue are subject to Sales and Use Tax, except 
    admission to racetracks taxed under KRS 138.480, admission to historical sites exempt under KRS 139.482, admission taxed under KRS 229.031, unarmed 
    combat show not licensed under KRS 229.061, and a portion of the admission to county fairs exempt under KRS 139.470.  Initiation fees, monthly fees, and 
    membership fees paid for the use of a facility or participating in an event or activity, regardless of whether the fee is paid per use or in any other form, are 
    subject to Sales and Use Tax (KRS139.010 (1)).
    Beginning March 26, 2019, admissions charged by nonprofit educational, charitable, religious institutions, non-profit civic, government or other non-profit 
    organizations are exempt from Sales and Use Tax (KRS 139.200(2)(c)).
    Beginning July 1, 2019, admissions paid to enter or participate in a fishing tournament, and any fee paid for the use of a boat ramp for the purposes of allowing 
    boats to be launched into or hauled out from water are exempt from Sales and Use Tax (KRS 139.010(1)(b)).
    Beginning August 1, 2020, all golf course admissions are subject to sales tax whether sold by a for-profit or a non-profit entity.

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10A100(P)(11-22) Page 10
31. Beginning July 1, 2018, a remote retailer selling tangible personal property or digital property delivered or transferred electronically to a purchaser in this
state if: the remote retailer sold tangible personal property or digital property that was delivered or transferred electronically to a purchaser in this state in
two hundred (200) or more separate transactions in the previous calendar year or the current calendar year; or the remote retailer’s gross receipts derived
from the sale of tangible personal property or digital property delivered or transferred electronically to a purchaser in this state in the previous calendar year
or current calendar year exceeds one hundred thousand dollars ($100,000) (KRS 139.340(g)).
32. You as the agent are required to hold a Kentucky Sales and Use Tax Permit, if the manufacturer for whom you sell does not hold a valid Kentucky Sales and
Use Tax Permit (KRS 139.010(39)).
33. “Marketplace” means any physical or electronic means through which one or more retailers may advertise and sell tangible personal property, digital
property, or services, or lease tangible personal property or digital property. Examples of a marketplace are: a catalog; an Internet website; or a television
or radio broadcast, regardless of whether the tangible personal property, digital property, or retailer is physically present in the Commonwealth of Kentucky.
KRS 139.010(23))
33a. ”Marketplace provider” means a person, including any affiliate of the person, that facilitates a retail sale directly or indirectly (KRS 139.010(24)(a-b)).
33b. ”Marketplace retailer” means a seller that makes retail sales through any marketplace owned, operated, or controlled by a marketplace provider.
(KRS 139.010(25))
33c. Businesses that operate an online marketplace and facilitate sales by a third party marketplace retailer must collect sales and use tax for the sales
transactions facilitated through the online marketplace in addition to the sales made on behalf of their own businesses. (KRS 139.450(2)) A business
facilitating online marketplace sales by a third party marketplace retailer may choose whether to register for one sales tax account for reporting both its
own sales and the sales it facilitates, OR to register for two separate sales tax accounts, one for reporting its own sales and the other for reporting the
sales it facilitates for others.
34. A contract miner or a fee processor is an independent party to whom a manufacturer/industrial processor pays a fee to perform a step or series of steps in the
manufacturing or mining process. Contract miners and fee processors may issue resale certificates for materials, supplies, and industrial tools used directly
in the manufacturing/mining process provided the tools have a useful life of less than one year. Resale certificates cannot be issued for repair, replacement
or spare parts.
35. Any vendor who contracts to sell, install, or provide services to the Commonwealth of Kentucky or one of its agencies, is required to register for Kentucky
Sales and Use Tax per KRS 45A.067, and collect and remit the Sales and Use Tax imposed by KRS Chapter 139. In order to complete the bidding process
with the Commonwealth or one of its agencies, an original application applying for a Sales and Use Tax Account or a copy of your Sales and Use Tax
Permit must be submitted with the bid packet. Failure to obtain the required account and remain in compliance with KRS Chapter 139 during the life of
your contract may result in termination of your contract with the Commonwealth (200 KAR 5:390).
36. If you make sales into Kentucky and are an affiliate of a company who contracts to sell, install, or provide services to the Commonwealth, you are required
to register for Kentucky Sales and Use Tax per KRS 45A.067 and collect and remit the Sales and Use Tax imposed by KRS Chapter 139.
37. The rental of any lodgings, campsites, or accommodations furnished by any campground or recreational vehicle park are subject to Sales and Use Tax
(KRS 139.200(2)(a)). The tax shall not apply to lodgings, campsites, or accommodations supplied for a continuous period of thirty days or more to a person.
38. All receipts collected from the Sales and Use Tax on the fees paid for breeding a stallion to a mare will be deposited into a fund, which will be administered
by the Kentucky Horse Racing Commission to enhance the equine breeding industry in the state. Taxpayers who report sales tax on equine breeding fees
are required to complete the Kentucky Sales and Use Tax Equine Breeders Supplementary Schedule (Form 51A132) with their Sales and Use Tax returns
per 103 KAR 27:240.
Note: Copies of this supplemental schedule are available at www.revenue.ky.gov or for more information contact the Division of Sales and Use Tax,
Department of Revenue, P.O. Box 181, Station 53, Frankfort, Kentucky 40602, or call (502) 564-5170.
39. All receipts collected from the Sales and Use Tax for aviation jet fuel will be deposited into the Kentucky Aviation Economic Development Fund which is
administered by the Kentucky Transportation Cabinet to enhance the aviation industry in the state. Taxpayers who report sales tax on aviation jet fuel sales
are required to complete the Kentucky Sales and Use Tax Monthly Aviation Fuel Dealer Supplementary Schedule (Form 51A131) with their Sales and Use
Tax returns.
Note: Copies of this supplemental schedule are available at www.revenue.ky.gov or for more information, contact the Division of Sales and Use Tax,
Department of Revenue, P.O. Box 181, Station 53, Frankfort, Kentucky 40602, or call (502) 564-5170.
40. Kentucky motor vehicle dealers who make sales of vehicles to residents of Arizona, California, Florida, Indiana, Massachusetts, Michigan, South Carolina,
or Washington must collect Kentucky Sales and Use Tax on the selling price of the vehicle, less the trade-in allowance for like-kind exchanges. These
receipts are to be reported and paid with the filing of the dealer’s regular Sales and Use Tax return. Taxpayers who report such sales are required to
complete and file a Kentucky Sales Tax Motor Vehicle Sales Supplementary Schedule (Form 51A135) which provides a breakdown for the portion of total
sales that relates specifically to sales of motor vehicles to those nonresident customers. The supplementary schedule is due on the same date as the
Sales and Use Tax return and may be filed online at www.revenue.ky.gov .
Note: For more information contact the Division of Sales and Use Tax, Department of Revenue, P.O. Box 181, Station 53, Frankfort, Kentucky 40602, or call
(502) 564-5170.
41. Temporary rental of rooms, lodgings, campsites, or other accommodations by any hotel, motel, inn, campground, recreational vehicle park, tourist camp, or
other place regularly providing accommodations to transients are subject to Sales and Use Tax (KRS 139.200) and Transient Room Tax. The Transient Room
Tax adds a one (1) percent tax of the rent in addition to the current 6 percent sales tax (KRS 142.400). “Temporary” does not apply to rooms, lodgings, or
accommodations supplied for a continuous period of thirty days or more to a person.
Note: For more information contact the Excise Financial Tax Section, Department of Revenue, P.O. Box 1303, Station 61, Frankfort, Kentucky 40602-1303,
or call (502) 564-6823.
42. Retail businesses which sell new tires for motor vehicles and semi-trailers are subject to Sales and Use Tax and the Motor Vehicle Tire Fee. Effective July 1,
2018, the fee imposed for each new motor vehicle tire sold in Kentucky is subject to the Kentucky sales tax. Effective July 1, 2020, a fee is imposed on new
trailer and semitrailer tires sold in Kentucky is subject to the Kentucky sales tax. (KRS 224.50-868(2)(a)(2) and (2)(a)(3))
Note: For more information contact the Financial Tax Section, Department of Revenue, P.O. Box 1303, Station 61, Frankfort, Kentucky 40602-1303, or
call (502) 564-4810.

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43. Per KRS 65.7621-.7643 and KRS 142.110, businesses required to collect the Commercial Mobile Radio Service (CMRS) Prepaid Service Charge from
consumers pursuant to KRS 65.7634 are required to register with the Department of Revenue and remit the CMRS prepaid service charge electronically.
(KRS 142.115; 103 KAR 1:160 sec. 4(2))
44. Businesses who perform manufacturing, industrial processing, mining, or refining who document that their cost of energy or energy-producing fuels exceeds
3 percent of the cost of production may submit an application for Energy Direct Pay (EDP) Authorization. Those businesses that choose to do so may also
apply for the EDP Utility Gross Receipts License Tax (UGRLT) exemption. A Sales and Use Tax Account number must be obtained by all businesses who
hold an EDP Authorization. Those businesses that are approved for the UGRLT EDP exemption are required to obtain a UGRLT account number to file and
remit the UGRLT monthly returns electronically. You must attach a copy of your official UGRLT Exemption Authorization to this application.
45. Sales of water utilities, gas utilities, electricity, or sewer services to nonresidential customers are subject to Sales and Use Tax. Communication services are
also subject to Sales and Use Tax.
*While the sale of cable, satellite broadcast, Internet protocol television services, and video streaming services are not subject to Sales and Use Tax,
cable services, satellite broadcast services, Internet protocol television services, video streaming services, and communication services are subject to
Telecommunications Tax (KRS Chapter 136).
Also, cable services, Internet protocol television services, video streaming services, communication services, and the other utility services listed above are
subject to Utility Gross Receipts License Tax (KRS 160.614).
Providers of cable services or Internet protocol services should check Box F. Providers of video streaming services should check Box G. Providers of
satellite services should check Box H.
Communication services (KRS 136.602 and KRS 160.6131) include, but are not limited to: local and long distance telephone services; telegraph and
teletypewriter services; pre-paid calling services and postpaid calling services; private communications services involving a direct channel specifically
dedicated to a customer’s use between specific points; channel services involving a path of communications between two (2) or more points; data transport
services involving the movement of encoded information between points by means of any electronic, radio, or other medium or method; caller ID services,
ring tones, voice mail, and other electronic messaging services; mobile wireless telecommunications service; and, fixed wireless service as defined in
KRS 139.195; and voice over Internet protocol (VOIP).
Note: For more information about Telecommunications Tax, contact the Division of Sales and Use Tax, Department of Revenue, P.O. Box 181, Station 66,
Frankfort, Kentucky 40602, or call (502) 564-5170 (Option 2). For more information about Utility Gross Receipts License Tax, contact the Financial Tax
Section, Department of Revenue, P. O. Box 181, Station 61, Frankfort, Kentucky 40602, or call (502) 564-4810 (KRS 136.600-136.660 and KRS 160.613).
46. If you make a purchases of any named utility type in question 45 B through G, mark Yes and list the provider’s name and utility type in 46b. Otherwise, check
No.
47. Per KRS 139.330, a 6 percent Use Tax is due if you make out-of-state purchases of tangible personal property, digital property, or taxable services under
KRS 139.200(2)(p) - (ay) for storage, use, or other consumption in Kentucky and did not pay at least 6 percent state Sales Tax to the seller at the time of
purchase. For example, if you order from catalogs, make purchases through the internet, or shop outside Kentucky for items such as construction supplies,
construction equipment, office furniture, computer equipment, medical equipment, software, office supplies, books, or subscribe to magazines or professional
journals, you will owe Use Tax to Kentucky. This list is not all-inclusive. It is important to remember that Use Tax applies only to items purchased outside
Kentucky, including another country, which would have been taxed if purchased in Kentucky.
Note: If your business did make or will make a one-time only out-of-state purchase or will not regularly make these types of purchases, check this question
No. Do not complete the section to apply for a Consumer’s Use Tax Account. You will need to complete Form 51A113(O), Consumer’s Use Tax Return, to
report and pay the applicable Use Tax. To obtain Form 51A113(O), call the Division of Sales and Use Tax at (502) 564-5170 or download the form from our
website at http://revenue.ky.gov .
All professional service providers must apply for a Consumer’s Use Tax Account.
48. For assistance, contact the Kentucky Secretary of State’s Office at (502) 564-3490 or visit them online at http://sos.ky.gov .
49. A commercial domicile is the principal place from which the trade or business of the corporation is managed (103 KAR 16:240).
50. Owning or leasing property in this state means owning or leasing real or tangible property in Kentucky, including: maintaining an office or other place of
business in Kentucky; maintaining in Kentucky an inventory of merchandise or material for sale, distribution or manufacture, or consigned goods, regardless
of whether kept on the taxpayer’s premises, in a public or rented warehouse, or otherwise; or owning computer software used in the business of a third party
within Kentucky (103 KAR 16:240). See definition in instruction 23 for tangible property.
51. Corporations and Limited Liability Entities with individuals performing services in Kentucky are subject to Kentucky Corporation Income Tax and/or Limited
Liability Entity Tax. The business is considered as performing services in Kentucky whether the services are provided directly by the business or indirectly
by directing activity performed by a third party (103 KAR 16:240). Services do not include the mere solicitation of the sale of tangible personal property.
52. A Pass-Through Entity is any partnership, joint venture, S corporation, limited cooperative association, statutory trust, series of a statutory trust, limited
partnership (LP), limited liability partnership (LLP), limited liability limited partnership (LLLP), series of a partnership, limited liability company (LLC),
professional limited liability company (PLLC), series of a limited liability company, or similar entity recognized by the laws of this state that is not taxed at
the entity level, but instead passes to each partner, member, shareholder, or owner their proportionate share of income, deductions, gains, losses, credits,
and any other similar attributes. You are required to register for a Kentucky Corporation Income Tax Account and/or a Limited Liability Entity Tax Account
to report the income generated from a pass-through entity (KRS 141.010) or otherwise derived from or attributable to sources in Kentucky.
53. Directing activities at Kentucky customers for the purpose of selling goods is taxable in Kentucky. This includes selling or soliciting orders for real property,
intangible personal property, tangible property, or delivering merchandise inventory on consignment to its Kentucky distributors or dealers. Directing activities
at Kentucky customers for the purpose of selling services, in addition to unprotected solicitation activities, is taxable in Kentucky (103 KAR 16:240).
54. Intangible property is subject to Kentucky Corporation Income Tax and/or Limited Liability Entity Tax (103 KAR 16:240).

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For Corporation Income Tax, nothing in questions 48 through 54 shall be interpreted in a manner that goes beyond the limitations imposed and
protections provided by the United States Constitution or Public Law No. 86-272. Public Law No. 86-272 does not apply to the Limited Liability Entity Tax.
55. See instruction 52 for an explanation of pass-through entities.
56a-56b If your pass-through entity has nonresident individual/corporate partner(s), individual/corporate member(s), or individual shareholder(s) that receive
Kentucky distributive share income from your pass-through entity, check Yes to A and/or B.
Note: For tax years beginning on or after January 1, 2007, every pass-through entity required to file a return under KRS 141.206(1) shall withhold
Kentucky income tax at the maximum rate provided in KRS 141.020 or 141.040 on the distributive share income, whether distributed or undistributed,
of each: (i) nonresident individual (includes a nonresident estate or trust) partner, member or shareholder; and (ii) corporate partner or member that is
doing business in Kentucky only through its ownership interest in a pass-through entity. The withholding shall be filed with the Department of Revenue on
Form 740NP-WH, Kentucky Nonresident Income Tax Withholding on Distributive Share Income Report and Composite Income Tax Return, on or before
the 15th day of the fourth month after the close of the pass-through entity’s taxable year, and shall include: (i) Form PTE-WH, Kentucky Nonresident
Income Tax Withholding on Distributive Share Income, for each nonresident individual partner, member, or shareholder and each corporate partner
or member included in Form 740NP-WH; and (ii) remittance of the income tax due. A copy of Form PTE-WH shall be provided to each nonresident
individual partner, member, or shareholder and each corporate partner or member included in Form 740NP-WH.
57. - 58. Every person engaged in severing and/or processing coal, including refuse coal, must file an application to obtain a Certificate of Registration and Coal
Seller/Purchaser Certificate ID Number with the Kentucky Department of Revenue before severing and/or processing coal in Kentucky (KRS 143.030).
Processing includes cleaning, breaking, sizing, dust allaying, treating to prevent freezing, or loading or unloading for any purpose. This is limited to
persons who own or have an economic interest in the coal and does not include a contract miner. Persons who only receive an arm’s length
royalty are not considered as having an economic interest and are not required to register.
Note: Persons required to obtain a Certificate of Registration for Coal Severance and Processing Tax must also apply for a Sales and Use Tax Permit
in Section E of this application.
59. Coal brokers, while not subject to coal tax, will be issued a Coal Seller/Purchaser Certificate ID Number that must be used in all sales and purchases
of coal on Form 55A004.
SECTION D—EMPLOYER’S WITHHOLDING TAX ACCOUNT
Note: Effective January 1, 2021, businesses that are monthly and twice-monthly filers must electronically file their withholding tax returns. Effective January 1,
2022, all filers must electronically file their withholding tax returns. For legal reference, see 103 KAR 18:150 Sec. 2(6) & (7).
60. Existing Tax Account—If an Employer’s Withholding Tax Account number has already been assigned to this business, check Yes and list the account
number in B.
If per Section A of the application your business was required to re-register for new accounts, or an Employer’s Withholding Tax Account was never assigned
to your business, check No and leave B blank.
61. Number of Kentucky Employees—Enter the total number of full-time and part-time persons expected to be employed yearly in Kentucky; including Kentucky
residents that perform work outside the state of Kentucky. For Kentucky businesses, who are for federal purposes electing taxation as corporations, include
officers who will be receiving compensation.
62. Date Wages or Pensions First Paid—Enter the date wages or pensions were or will be paid to employees.
63. Estimated Total Annual Tax Withheld—Check the estimated dollar amount of withholding you will be remitting to the Department of Revenue on an annual
basis.
64. Common Paymaster or Common Pay Agent—If your business will report the withholding for your employees through an account issued to a Common
Paymaster or Common Pay Agent instead of an account issued to your business, check Yes and attach a listing of the information for the Common Paymaster
or Common Pay Agent you are contracted with to this application.
Common Paymaster—Two or more related corporations employing the same individual at the same time and paying this individual through one of the
corporations which is designated as the “common paymaster”. The common paymaster is responsible for filing information and tax returns and issuing Forms
K-2 with respect to wages.
Common Pay Agent—An independent third party your business has contracted with for filing information and tax returns and issuing Forms K-2 on behalf of
your business and for which you have filed federal Form 2678, Employer/Payer Appointment of Agent, to appoint them as your agent.
65. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate
box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and
list which account address you wish to use.
If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, ZIP Code, county (if in Kentucky), and the telephone
number for this address in this section. You may include a P. O. Box here.

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10A100(P)(11-22) Page 13
SECTION E—SALES AND USE TAX ACCOUNT (Including Transient Room Tax Account, Motor Vehicle Tire Fee Account, and Commercial Mobile Radio
Service (CMRS) Prepaid Service Charge Account)
Note: Effective October 1, 2021, businesses must electronically file and pay their Sales and Use, Transient Room, Motor Vehicle Tire Fee, and Commercial Mobile
Radio Service tax returns. For legal reference, see 103 KAR 1:160.
66. Existing Tax Account—If a Sales and Use Tax Account number has already been assigned to this business, check Yes and list the account number in B.
If per Section A of the application your business was required to re-register for new accounts, or a Sales and Use Tax Account was never assigned to your
business, check No and leave B blank.
67. Date Sales Began or Will Begin—Give the date that sales, services, repairs, rentals, leases, lodgings, or admissions began or will begin in Kentucky.
68. Estimated Gross Monthly Sales Tax Collected—Check estimated amount of monthly sales tax collected in Kentucky.
69. Additional Kentucky Locations—If you have additional business locations in Kentucky, check Yes. For each location, attach a listing of the information
found in question 69B.
70. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate
box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and
list which account address you wish to use.
If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone
number for this address in this section. You may include a P. O. Box here.
SECTION F—UTILITY GROSS RECEIPTS LICENSE TAX ACCOUNT
Note: Tax returns for Utility Gross Receipts License Tax are required to be filed online. See the application for the website addresses to use to register for online
filing once your account has been assigned.
71. Existing Tax Account—If a Utility Gross Receipts License Tax Account number has already been assigned to this business, check Yes and list the account
number in B.
If per Section A of the application your business was required to re-register for new accounts, or a Utility Gross Receipts License Tax Account was never
assigned to your business, check No and leave B blank.
72. Date Sales or Purchases of Utilities Began or Will Begin—Give the date sales of communications, multichannel video programming services, and/or
direct broadcast satellite services, water utilities, natural, artificial, or mixed gas, electricity, or sewer services began or will begin in Kentucky.
73. Telephone Number—List the telephone number for the business.
74. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate
box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and
list which account address you wish to use.
If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone
number for this address in this section. You may include a P. O. Box here.
SECTION G—TELECOMMUNICATIONS TAX ACCOUNT
Note: Tax returns for Telecommunications Tax are required to be filed online. See the application for the website address to use to register for online filing once
your account has been assigned.
75. Existing Tax Account—If a Telecommunications Tax Account number has already been assigned to this business, check Yes and list the account number
in B.
If per Section A of the application your business was required to re-register for new accounts, or a Telecommunications Tax Account was never assigned to
your business, check No and leave B blank.
76. Tangible Personal Property—If your business has tangible personal property located in Kentucky, check Yes. See instruction 23 for a definition of tangible
property.
Note: If you answered Yes, you are required to centrally file an annual property tax return titled Revenue Form 61A500(P), Personal Property Tax Forms
and Instructions for Communications Service Providers & Multichannel Video Programming Service Providers. This return is due May 15 and is filed with the
Office of Property Valuation, Division of State Valuation, Public Service Branch, Station 32, 4th Floor, 501 High Street, Frankfort, KY 40601-2103. For more
information call (502) 564-8175.
77. Company Types—Select the appropriate company type for your business.
78. Date Sales of Communications Began or Will Begin—Give the date sales of communications, multichannel video programming services, and/or direct
broadcast satellite services began or will begin in Kentucky.
79. Telephone Number—List the telephone number for the business.
80. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate
box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and
list which account address you wish to use.
If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone
number for this address in this section. You may include a P. O. Box here.

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10A100(P)(11-22) Page 14

SECTION H—CONSUMER’S USE TAX ACCOUNT
81. Existing Tax Account—If a Consumer’s Use Tax Account number has already been assigned to this business, check Yes and list the account number in B.
If per Section A of the application, your business was required to re-register for new accounts, or a Consumer’s Use Tax Account was never assigned to your
business, check No and leave B blank.
82. Date Purchases Began or Will Begin—Give the date that purchases of tangible property, digital property, or taxable services under KRS 139.200(2)(p) -
(ay) began or will begin.
83. Send Mail Related to this Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate
box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and
list which account address you wish to use.
If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone
number for this address in this section. You may include a P. O. Box here.

SECTION I—CORPORATION INCOME TAX ACCOUNT AND/OR LIMITED LIABILITY ENTITY TAX ACCOUNT
Note: All corporations and all limited liability entities should be registered with the Kentucky Secretary of State’s Office in order to conduct business within
Kentucky. You may contact their office at (502) 564-3490, or visit their website at http://sos.ky.gov to determine your registration requirements.
84. Existing Tax Account—If a Corporation Income Tax and/or a Limited Liability Entity Tax Account number has already been assigned to this business, check
Yes and list the account number in B.
If per Section A of the application, your business was required to re-register for new accounts, or a Corporation Income Tax or a Limited Liability Entity Tax
Account was never assigned to your business, check No and leave B blank.
85. Entity Treated as a Division—If your entity is not separately taxed and is instead federally treated as a division of a parent company, check Yes and select
the division type in item B.
86. Mere Solicitation—If you are an out-of-state entity, check if your activity in Kentucky is mere solicitation of the sale of tangible property which is protected
under Public Law 86-272. Public Law 86-272 does not apply to the Limited Liabililty Entity Tax.
87. Date Activity Began for Out-of-State Entities—Enter the date that your business or organization began business activities in Kentucky or began receiving
pass-through income from Kentucky sources.
88. Exempt Organizations—Indicate whether your business or organization is exempt from Corporation Income Tax and/or Limited Liability Entity Tax by
Kentucky statute. If Yes, see Exemption Table 1 and enter the appropriate code that matches your exemption type in item B.
If you select “Political Organization” in B, indicate in item C whether your entity is required to file federal Form 1120-POL.
Note to corporations exempt from federal income taxation: Corporations which are exempt from federal income taxation under Section 501(c)(3) of the
Internal Revenue Code, must attach a copy of the determination of exemption letter issued by the IRS.
89. Send Mail Related to this Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate
box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and
list which account address you wish to use.
If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone
number for this address in this section. You may include a P. O. Box here.

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10A100(P)(11-22)                                                                                                                           Page 15

                                                              EXEMPTION TABLE 1

                         EXEMPTION TYPE                                                                                               CODE
Insurance company, including farmers or other mutual hail, cyclone, windstorm, or fire insurance companies, insurers, and             6
reciprocal underwriters (does not include insurance agencies) 
Corporation or other entity exempt under Section 501 of the Internal Revenue Code                                                     7

Religious, educational, charitable, or like corporation not organized or conducted for pecuniary profit                               8

Corporation whose only owned or leased property located in this state is located at the premises of a printer with which it has       9
contracted for printing, provided that: 1. The property consists of the final printed product, or copy from which the printed product 
is produced; and 2. The corporation has no individuals receiving compensation in this state as provided in KRS 141.120(8)(b)

Public service corporation subject to tax under KRS 136.120                                                                           10

Open-end registered investment company organized under the laws of this state and registered under the Investment Com-                11
pany Act of 1940
Any property or facility which has been certified as a fluidized bed energy production facility as defined in KRS 211.390             12

An alcohol production facility as defined in KRS 247.910                                                                              13

Real estate investment trust (REIT) as defined in Section 856 of the Internal Revenue Code                                            14

Captive real estate investment trust (Captive REIT)                                                                                   15

Regulated investment company (RIC) as defined in Section 851 of the Internal Revenue Code                                             16

Real estate mortgage investment conduit (REMIC) as defined in Section 860D of the Internal Revenue Code                               17

Personal service corporation as defined in Section 269A(b)(1) of the Internal Revenue Code                                            18

Qualified investment partnership (QIP) as defined in KRS 141.206(14)                                                                  21

Cooperative described in Sections 521 and 1381 of the Internal Revenue Code (Select category below)

Farmers’ agricultural and other cooperatives organized or recognized under KRS Chapter 272                                            19A

Advertising cooperatives                                                                                                              19B

Purchasing cooperatives                                                                                                               19C

Homeowner’s associations including those described in Section 528 of the Internal Revenue Code                                        19D

Political organizations as defined in Section 527 of the Internal Revenue Code                                                        19E/F

Rural electric and rural telephone cooperatives                                                                                       19G

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10A100(P)(11-22) Page 16
SECTION J—KENTUCKY NONRESIDENT INCOME TAX WITHHOLDING ON DISTRIBUTIVE SHARE INCOME TAX ACCOUNT
90. Existing Tax Account—If a Kentucky Nonresident Income Tax Withholding on Distributive Share Income Tax Account number has already been assigned
to this business, check Yes and list the account number in B.
If per Section A of the application your business was required to re-register for new accounts, or a Kentucky Nonresident Income Tax Withholding on Distributive
Share Income Tax Account was never assigned to your business, check No and leave B blank.
91. Date First Nonresident Corporation or Individual Became a Partner, Member, or Shareholder—Enter the date that your business or organization received
its first Kentucky nonresident partner, member, or shareholder.
92. Exempt Organizations—Indicate whether your business or organization is exempt from Kentucky Nonresident Income Tax Withholding on Distributive Share
Income Tax by Kentucky statute. If Yes, see Exemption Table 2 below and enter the appropriate code that matches your exemption type in item B.
93. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate
box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and
list which account address you wish to use.
If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone
number for this address in this section. You may include a P. O. Box here.

EXEMPTION TABLE 2

EXEMPTION TYPE CODE
Insurance company, including farmers or other mutual hail, cyclone, windstorm, or fire insurance companies, insurers, and 6
reciprocal underwriters (does not include insurance agencies)
Corporation or other entity exempt under Section 501 of the Internal Revenue Code 7

Religious, educational, charitable, or like corporation not organized or conducted for pecuniary profit 8

Corporation whose only owned or leased property located in this state is located at the premises of a printer with which it has 9
contracted for printing, provided that: 1. The property consists of the final printed product, or copy from which the printed product
is produced; and 2. The corporation has no individuals receiving compensation in this state as provided in KRS 141.120(8)(b)

Qualified Investment Partnership (QIP) as defined in KRS 141.206(14) 21

Publicly Traded Partnership as defined in KRS 141.0401(6)(b)(14) 22

Qualified Subchapter S-Corporation Subsidiary (QSUB) 23

SECTION K—COAL SEVERANCE/PROCESSING TAX AND/OR COAL SELLER/PURCHASER CERTIFICATE ID NUMBER
94. Existing Tax Account—If a Coal Severance/Processing Tax Account number and/or a Coal Seller/Purchaser Certificate ID number has already been assigned
to this business, check Yes and list the account number(s) in B and/or C.
If per Section A of the application your business was required to re-register for new accounts, or a Coal Severance/Processing Tax Account number or a
Coal Seller/Purchaser Certificate ID number was never assigned to your business, check No and leave B blank.
95. Date Mining/Processing and/or Coal Brokering Began or Will Begin—Give the date mining/coal processing and/or coal brokering began or will begin in
Kentucky.
96. Send Mail Related to This Account to—If your mailing address is the same as the Business Location Address listed on Page 2, then check the appropriate
box. If the mailing address for this tax account is the same as a mailing address you entered in another application section, check the appropriate box and
list which account address you wish to use.
If you want tax correspondence to be sent somewhere else, complete the mailing address, city, state, Zip Code, county (if in Kentucky), and the telephone
number for this address in this section. You may include a P. O. Box here.

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