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10A104-I (06-17) Page 2
10. Additional Mining Locations— Do you operate additional partners’/members’ information. If there are more than two
mine locations? If yes, attach continuation pages to this partners/members to update, attach a separate sheet.
form listing the information requested in Question 9 for each
additional Kentucky mine location you operate. • For a Corporation, S Corporation, Government,
Association, REIT, RIC, REMIC, Trust or Non–profit —
SECTION D—SALES AND USE TAX LOCATION INFORMATION Enter the updated officers’ information. If there are more
than two officers to update, attach a separate sheet.
11. Update or Close an Existing Business Location—Select
the box to indicate Close Location or Update/Move Location. To SECTION F—UPDATE MAILING ADDRESS AND PHONE NUMBERS
update an existing Business Location for your Sales and Use FOR TAX ACCOUNTS
Tax Account, list the old and new addresses for the location. 18. Start Date for Address Change—Enter the start date for the
(If you have multiple locations to update, attach a separate mailing address change.
listing of the information in Question 11).
19. Tax Accounts for which the Address Change Applies —
12. - 13. Open a New Location of Current Business—List the Check the box(es) for all tax accounts for which the address
new address, telephone number, description of the activities and/or phone number change applies.
performed at the new location and the date the location will
open. (If you have more than two locations to add, attach a 20. List New Mailing Address—Complete the mailing address,
separate listing of the information in Questions 12-13). city, state, zip code, county if mailing address is in Kentucky,
and the telephone number for the address in this section. You
may include a PO Box here.
SECTION E—UPDATE ACCOUNTING PERIOD, OWNERSHIP TYPE,
AND/OR RESPONSIBLE PARTIES 21. Start Date for Address Change—If you have a second
address change for tax accounts other than the ones checked
14. Accounting Period Change with the IRS—Indicate the new in Question 19, enter start date for the mailing address change.
information if you have changed your Accounting Period with
the Internal Revenue Service (IRS). 22. Tax Accounts for which the Address Change Applies —
Check the box(es) for all tax accounts for which the second
15. Taxing Election Change with the IRS— address and/or phone number change applies.
A. Enter your current Business Structure.
B. Indicate the old and new taxing elections. 23. List New Mailing Address—Complete the mailing address,
city, state, zip code, county if mailing address is in Kentucky,
16. - 17. Ownership Disclosure—Responsible Party Update — and the telephone number for the second address in this
Enter the full legal name, Social Security Number or FEIN, section. You may include a PO Box here.
Driver’s License Number, Driver’s License State of Issuance,
Business Title, Effective Date of Title, residence street SECTION G—REQUEST FOR CANCELLATION OF ACCOUNT(S)
address, city, state, zip code, telephone number, and county
(if Kentucky). 24. Tax Accounts for which Cancellation is Requested—Check
the box(es) for the account(s) you wish to have cancelled.
NOTE: You are required to provide your Social Security
Number on tax forms per Section 405, Title 42, of the United 25. Reason for Cancellation—Check the box that corresponds to
States Code. This information will be used to establish the reason the account should be cancelled. If “Other” selected,
your identity for tax purposes. enter reason.
If this responsible party will replace an existing responsible 26. Effective Date to Cancel Account(s)—Enter the last date of
party listed on your tax accounts, check the box and list the operations or activity for the account type you are requesting
previous responsible party’s name and the date they ceased cancellation.
being in their listed title. NOTE: A corporation’s or limited liability pass-through
entity’s income tax/LLET account number is cancelled
• For a Sole Proprietorship or an LLC (for Federal with the filing of the “final” return. A corporation or
Purposes Taxed as an Individual)—Enter the original limited liability pass-through entity organized in Kentucky
owner’s updated information. If there is a new owner, shall not file a final return before it is officially dissolved
updates cannot be made. You must apply for new accounts pursuant to the provisions of KRS Chapter 14A.
using the Kentucky Tax Registration Application, Form
10A100. 27. If Business Sold—List the name, address and telephone
number for the new owners.
• For an LLC (for Federal Purposes Taxed as a Single
Member Disregarded Entity)—Enter the single member’s 28. If Merged out of Existence—List the name, FEIN, address
updated company information in Question 16. If the LLC and telephone number of the surviving business.
has managers, their updated information can be entered
in Question 17. Attach a separate sheet for more LLC
managers.
The Kentucky Department of Revenue does not
• For a Joint Venture, General Partnership, Limited discriminate on the basis of race, color, national origin,
Partnership, LLP, LLLP, or LLC (for Federal Purposes sex, age, religion, disability, sexual orientation, gender
Taxed as a Partnership, Corporation, S Corporation, identity, veteran status, genetic information or ancestry
or Non–profit)—Enter the updated information for the in employment or the provision of services.
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