††††† 103 KAR 3:050. Miscellaneous Taxes Forms manual.

 

††††† RELATES TO: KRS 42.470, 61.870-61.884, 131.020-131.130, 131.155, 131.170, 131.181, 131.183, 131.190, 131.340, 131.500, 131.510, 131.540, 132.020, 132.130-132.180, 132.190, 132.200, 132.220-132.270, 132.290-132.320, 132.450, 132.487, 132.510, 132.820, 132.990, 133.045, 133.110, 133.120, 133.130, 133.240, 134.420, 134.580, 134.590, 134.800-134.830, 135.010, 135.020, 135.050, 136.020, 136.050, 136.070, 136.071, 136.0704, 136.090, 136.100, 136.115-136.180, 136.1873, 136.310-136.335, 136.377, 136.392, 136.545, 136.575, 136.600-136.660, 137.130, 137.160, 138.165, 138.195, 138.210-138.885, 140.010-140.360, 142.010-142.404, 143.030, 143.037, 143.040, 143.050, 143.060, 143.085, 143.990, 143A.010, 143A.030, 143A.035, 143A.037, 143A.080, 143A.090, 143A.100, 143A.991, 154.22-50-154.22-070, 154.23-010, 154.24-110, 154.24-130, 154.26-090, 154.28-090, 154.34-010, 155.170, 160.613-160.617, 209.160, 224.1-310, 224.60, 234.321, 234.370, 243.710-243.884, 248.756, 299.530, 304.4-030, 304.11-050, 304.49-220, 351.175, 395.470, 413.120

††††† STATUTORY AUTHORITY: KRS 131.130(3)

††††† NECESSITY, FUNCTION, AND CONFORMITY: KRS 131.130(3) authorizes the Department of Revenue to prescribe forms necessary for the administration of any revenue law by the promulgation of an administrative regulation incorporating the forms by reference. This administrative regulation incorporates by reference the required Revenue Forms used in the administration of miscellaneous taxes by the Department of Revenue other than Income Taxes, Sales and Use Taxes, Telecommunications Excise and Gross Revenues Tax, Severance Taxes, and Property Taxes.

 

††††† Section 1. Alcoholic Beverage Tax. (1) Revenue Form 73A504, Acknowledgment of Tax Liability on Imported Alcoholic Beverages, shall be used by persons importing distilled spirits, wine, and malt beverages into Kentucky through the United States Bureau of Customs for personal consumption in this state to acknowledge liability for the alcoholic beverage excise tax.

††††† (2) Revenue Form 73A525, Monthly Report of Distillers, Rectifiers or Bottlers, shall be used by distillers, rectifiers, or bottlers of distilled spirits to report liability for distilled spirits excise tax and wholesale sales tax.

††††† (3) Revenue Form 73A526, Wholesalerís Monthly Distilled Spirits Tax Report, shall be used by wholesalers of distilled spirits to report liability for distilled spirits excise tax, wholesale sales tax, and case sales tax.

††††† (4) Revenue Form 73A527, Wholesalerís List of Individual Spirits Shipments Acquired, shall be used by wholesalers of distilled spirits to itemize monthly receipts of distilled spirits from all sources.

††††† (5) Revenue Form 73A529, Consignorís Report of Alcoholic Beverages Shipped, shall be used by consignors of distilled spirits and wine to report trafficking in alcoholic beverages during the previous month.

††††† (6) Revenue Form 73A530, Consignorís Report of Alcoholic Beverages Shipped, shall be used by consignors of distilled spirits and wine to report trafficking in alcoholic beverages during the previous month.

††††† (7) Revenue Form 73A531, Transporterís Report of Alcoholic Beverages Delivered, shall be used by transporters of distilled spirits, wine, and malt beverages to report shipments of alcoholic beverages delivered into the state during the previous month.

††††† (8) Revenue Form 73A535, Report of Destruction of Alcoholic Beverages, shall be used by governmental officials to certify quantities of tax-paid alcoholic beverages no longer suitable for consumption that are destroyed in the official's presence.

††††† (9) Revenue Form 73A575, Wholesalerís Monthly Wine Tax Report, shall be used by wine wholesalers to report liability for wine excise tax and wine wholesale sales tax.

††††† (10) Revenue Form 73A576, Vintnerís Wine Report, shall be used by vintners to report liability for wine excise tax and wine wholesale sales tax.

††††† (11) Revenue Form 73A577, Wholesalerís List of Individual Wine Shipments Acquired, shall be used by wine wholesalers to report shipments of wine received during the previous month.

††††† (12) Revenue Form 73A626, Brewerís Monthly Report Schedule, shall be used by brewers of malt beverages to report sales and distribution of malt beverages into Kentucky.

††††† (13) Revenue Form 73A627, Beer Distributorís Monthly Report, shall be used by beer distributors to report shipments of malt beverages received during the previous month.

††††† (14) Revenue Form 73A628, Distributor's Monthly Malt Beverage Wholesale Sales Tax and Excise Tax Report, shall be used by distributors of malt beverages to report liability for malt beverage excise tax and malt beverage wholesale sales tax. Microbreweries shall use the form to report malt beverage excise tax.

††††† (15) Revenue Form 73A628(I), Instructions for Distributorís Monthly Malt Beverage Wholesale Sales Tax and Excise Tax Report, shall be used by distributors and microbrewers of malt beverages to file Revenue Form 73A628.

††††† (16) Revenue Form 73A629, Beer Distributorís Sales to Federal Agencies, shall be used by beer distributors to report shipments of malt beverages to federal military agencies.

††††† (17) Revenue Form 73A630, Microbrewerís Retail Gross Receipts Report to Distributor, shall be used by microbreweries to report liability for malt beverage wholesale sales tax.

 

††††† Section 2. Bank Franchise Tax - Required Forms. (1) Revenue Form 73A800, Kentucky Registration Application for Bank Franchise Tax, shall be used by financial institutions which are regularly engaged in business in Kentucky to register for the Kentucky Bank Franchise Tax.

††††† (2) Revenue Form 73A801(P), 2015 Kentucky Bank Franchise Tax Forms and Instructions, shall be the packet used by financial institutions to register for the Kentucky Bank Franchise Tax, to determine the net capital and annual tax due, and to request a ninety (90) day extension of time to file the Kentucky Bank Franchise Tax Return.

††††† (3) Revenue Form 73A801, Bank Franchise Tax Return, shall be used by financial institutions to determine the net capital and Kentucky Bank Franchise Tax due for the calendar year 2015.

††††† (4) Revenue Form 73A802, Application for 90-Day Extension of Time to File Kentucky Bank Franchise Tax Return, shall be used by financial institutions to request a ninety (90) day extension of time to file the Kentucky Bank Franchise Tax Return.

 

††††† Section 3. Cigarette and Tobacco Tax - Required Forms. (1) Revenue Form 73A181, Application for Cigarette and Tobacco Products Licenses, shall be used by persons interested in acting as a cigarette wholesaler, subjobber, vending machine operator, transporter, unclassified acquirer, tobacco products distributor, or retail distributor to apply for the necessary license.

††††† (2) Revenue Form 73A190, Cigarette and Tobacco Products License, shall be used by the Department of Revenue to give evidence to cigarette wholesalers, subjobbers, vending machine operators, transporters, unclassified acquirers, tobacco products distributors, and retail distributors that they have been granted the appropriate license.

††††† (3) Revenue Form 73A404, Cigarette Tax Stamps Order Form, shall be used by licensed cigarette wholesalers or unclassified acquirers to order cigarette tax stamps.

††††† (4) Revenue Form 73A406, Cigarette Tax Credit Certificate, shall be used by the Department of Revenue to give credit to a licensed cigarette wholesaler or unclassified acquirer for cigarette tax stamps returned or destroyed.

††††† (5) Revenue Form 73A409, Cigarette Evidence/Property Receipt, shall be used by compliance officers and the property owner to acknowledge custody of seized goods.

††††† (6) Revenue Form 73A420, Monthly Report of Cigarette Wholesaler, shall be used by a licensed cigarette wholesaler to report cigarette inventory, tax stamp reconciliation, and liability for cigarette administration and enforcement fee and to report cigarettes that were purchased from manufacturers and importers of cigarettes who did not sign the Master Settlement Agreement (nonparticipating manufacturers).

††††† (7) Revenue Form 73A420(I), Instructions for Monthly Report of Cigarette Wholesaler, shall be used by cigarette wholesalers to file Revenue Form 73A420.

††††† (8) Revenue Form 73A421, 2009 Inventory Floor Tax for Cigarettes, Other Tobacco Products (OTP), and Snuff for Inventories as of March 31, 2009, shall be used by cigarette retailers or licensees to report cigarette inventories and the one-time inventory floor tax.

††††† (9) Revenue Form 73A421A, 2009 Inventory Floor Tax for Cigarettes, Other Tobacco Products (OTP), and Snuff, shall be used by cigarette retailers or licensees to report and pay installment two (2) of the one-time inventory floor tax.

††††† (10) Revenue Form 73A421B, 2009 Inventory Floor Tax for Cigarettes, Other Tobacco Products (OTP), and Snuff, shall be used by cigarette retailers or licensees to report and pay installment three (3) of the one-time inventory floor tax.

††††† (11) Revenue Form 73A421W, 2009 Inventory Floor Tax for Cigarettes, Other Tobacco Products (OTP), and Snuff, shall be used by cigarette licensees to report cigarette and stamp inventories and the one-time inventory floor tax.

††††† (12) Revenue Form 73A422, Monthly Report of Tobacco Products, Snuff, and Chewing Tobacco, shall be used by tobacco licensees to report liability for tobacco products tax, snuff tax, and chewing tobacco tax.

††††† (13) Revenue Form 73A422(I), Instructions for Monthly Report of Tobacco Products, Snuff, and Chewing Tobacco, shall be used by tobacco products distributors and retail distributors to file Revenue Form 73A422.

††††† (14) Revenue Form 73A450, Retail Tobacco Inspection Report, shall be used to document information obtained during retail tobacco inspections.

††††† (15) Revenue Form 73B401, Cigarette Tax Credit Claim Wholesalerís Affidavit, shall be signed by a licensed cigarette wholesaler attesting that the reported tax evidence did or did not have the thirty (30) cents surtax paid on it.

 

††††† Section 4. Health Care Provider Tax. (1) Revenue Form 73A060, Health Care Provider Tax Return, shall be used by taxpayers to file the gross revenues and compute the tax for the health care provider tax.

††††† (2) Revenue Form 73A060(I), Instructions - Kentucky Health Care Provider Tax Return, shall be used by the taxpayers to determine if the service they provide is taxable, what tax rate is applicable, and which line to use for reporting.

††††† (3) Revenue Form 73A061, Kentucky Health Care Provider Application for Certificate of Registration, shall be completed by the taxpayer to register for the health care provider tax.

 

††††† Section 5. Inheritance Tax - Required Forms. (1) Revenue Form 92A121, Acceptance of Inheritance and Estate Tax Return, shall be sent by the inheritance and estate tax section to the personal representative or beneficiary of an estate to certify that all death taxes due the Commonwealth have been paid.

††††† (2) Revenue Form 92A200, Kentucky Inheritance Tax Return, shall be used by the personal representative or beneficiary of a resident or nonresident estate to establish the inheritance tax due the Commonwealth.

††††† (3) Revenue Form 92A200P, Kentucky Inheritance and Estate Tax Forms and Instructions, shall be used by the personal representative or beneficiary of a resident or nonresident estate to establish the inheritance tax due the Commonwealth for deaths occurring on or after January 1, 2005.

††††† (4) Revenue Form 92A201, Kentucky Inheritance Tax Return No Tax Due, shall be used by the personal representative or beneficiary of a resident or nonresident estate to establish that there is no inheritance tax due the Commonwealth.

††††† (5) Revenue Form 92A204, Real Estate Valuation Information Form, shall be used by the personal representative or beneficiary of an estate to establish the taxable value of real estate for inheritance tax purposes.

††††† (6) Revenue Form 92A205, Kentucky Inheritance Tax Return (Short Form), shall be used by the personal representative or beneficiary of a small or uncomplicated resident or nonresident estate to establish the inheritance tax due the Commonwealth.

††††† (7) Revenue Form 92A300, Affidavit of Exemption, shall be used by the fiduciary or beneficiary of the estate stating that all assets of the estate passed to exempt beneficiaries pursuant to KRS 140.080 or exempt organizations pursuant to KRS 140.060.

††††† (8) Revenue Form 92A928, Election to Defer the Payment of Inheritance Tax through Installments, shall be used by the beneficiary or beneficiaries of an estate to defer the payment of inheritance tax through installments.

††††† (9) Revenue Form 92A929, Notice of Agricultural and Horticultural Inheritance Tax Lien, shall be used to request the county clerk to place a lien on a particular piece of real estate due to the personal representative, on behalf of an estate, electing the use of agricultural or horticultural value.

††††† (10) Revenue Form 92A930, Certificate of Release of Agricultural and Horticultural Inheritance Tax Lien, shall be used by the inheritance and estate tax section to request the county clerk to release the five (5) year lien that guaranteed collection of tax if the terms of the agreement are not met or if the five (5) years have expired.

††††† (11) Revenue Form 92A931, Certificate of Partial Discharge of the Agricultural and Horticultural Inheritance Tax Lien, shall be used by the inheritance and estate tax section to request the county clerk to do a partial release of the five (5) year lien that guaranteed collection of tax if the terms of the agreement are not met or if the five (5) years have expired.

††††† (12) Revenue Form 92A932, Receipt of Inheritance and Estate Taxes, shall be given to the taxpayer when tax payment is received in the office.

††††† (13) Revenue Form 92A936, Election to Qualify Terminable Interest Property and/or Power of Appointment Property, shall be used by a personal representative or beneficiary to elect to qualify terminable interest property or power of appointment property if proper criteria exists.

††††† (14) Revenue Form 92F001, Inheritance Tax Lien Releases and Inventory of Safe Deposit Boxes, shall be used to access lock boxes without requiring written consent or presence of the Department of Revenue or local PVA official and shall provide a blanket lien release on all property owned by any decedent.

††††† (15) Revenue Form 92F101, A Guide to Kentucky Inheritance and Estate Taxes, shall be used by the general public for information purposes concerning Kentucky inheritance and estate tax.

 

††††† Section 6. Insurance Tax - Required Forms. (1) Revenue Form 74A100, Insurance Premiums Tax Return, shall be used by domestic and foreign life insurance companies, stock insurance companies other than life, and foreign mutual companies other than life to report liability for domestic and foreign life insurance tax, other than life insurance tax, fire insurance tax and retaliatory taxes and fees.

††††† (2) Revenue Form 74A101, Insurance Premiums Tax Return - Domestic Mutual, Domestic Mutual Fire, or Cooperative and Assessment Fire Insurance Companies, shall be used by domestic mutual, domestic mutual fire or cooperative and assessment fire insurance companies to report liability for premiums tax on amounts paid to authorized and unauthorized reinsurance companies.

††††† (3) Revenue Form 74A105, Unauthorized Insurance Tax Return, shall be used by insurers not authorized to conduct business in the Commonwealth of Kentucky by the Department of Insurance to report liability for insurance premiums tax.

††††† (4) Revenue Form 74A106, Insurance Premiums Tax Return - Captive Insurer, shall be completed by domestic and foreign insurance companies to report captive insurance tax.

††††† (5) Revenue Form 74A110, Kentucky Estimated Insurance Premiums Tax for Calendar Year 2016, shall be used by insurance companies to remit estimated premiums tax payments.

††††† (6) Revenue Form 74A116, Tax Election for Domestic Life Insurance Companies, shall be used by domestic life insurance companies to make an irrevocable election to pay state capital and reserves tax, premiums tax, and the county and city capital and reserves tax or to pay state premiums tax and local government premiums tax.

††††† (7) Revenue Form 74A117, Monthly Insurance Surcharge Report - Domestic Mutual, Cooperative and Assessment Fire Insurer, shall be used by domestic mutual, cooperative and assessment fire insurers to report liability for insurance premium surcharge.

††††† (8) Revenue Form 74A117A, Insurance Surcharge Report Ė Domestic Mutual, Cooperative and Assessment Fire Insurer, shall be used by domestic mutual, cooperative and assessment fire insurers to report liability for insurance premium surcharge.

††††† (9) Revenue Form 74A118, Monthly Insurance Surcharge Report, shall be used by domestic, foreign and alien insurers, other than life and health insurers, to report liability for an insurance premium surcharge.

††††† (10) Revenue Form 74A118A, Insurance Surcharge Report, shall be used by domestic, foreign and alien insurers, other than life and health insurers, to report liability for an insurance premium surcharge.

 

††††† Section 7. Legal Process - Required Forms. (1) Revenue Form 73A200, County Clerkís Monthly Report of Legal Process Tax Receipts, shall be used by the county clerks to report the countyís liability for the legal process tax and spouse abuse shelter fund.

††††† (2) Revenue Form 73A201, Quarterly Report of Affordable Housing Trust Fund Fee, shall be used by the county clerks to report the countyís liability for the affordable housing trust fund fee.

 

††††† Section 8. Marijuana and Controlled Substance - Required Forms. (1) Revenue Form 73A701, Instructions for Affixing Marijuana and Controlled Substance Tax Evidence (Stamp), shall be used by the Kentucky Department of Revenue to provide persons ordering marijuana and controlled substance tax stamps with the appropriate instructions on affixing the stamps.

††††† (2) Revenue Form 73A702, Notice of Tax Lien KRS 138.870 Marijuana and Controlled Substance Tax, shall be used by law enforcement officials to notify the Kentucky Department of Revenue and county clerks of the seizure of marijuana and other controlled substances.

††††† (3) Revenue Form 73A703, Marijuana or Controlled Substance Stamp Order Form, shall be used by taxpayers to order stamps for marijuana or controlled substances.

 

††††† Section 9. Motor Fuels - Required Forms. (1) Revenue Form 72A004, Motor Fuels Tax Watercraft Refund Bond, shall be used by an approved surety to establish surety obligation upon the payment to the Commonwealth of any refunds to which the public boat dock refund applicant was not entitled.

††††† (2) Revenue Form 72A005, Application for Approval to Sell Watercraft Refund Motor Fuels - Public Boat Dock, shall be used by a public boat dock owner to apply for approval to sell watercraft refund motor fuels.

††††† (3) Revenue Form 72A006, Motor Fuel Tax Refund Application - Public Boat Dock, shall be used by a public boat dock refund applicant to make application for refund of liquid fuel tax on purchases of liquid fuel delivered directly to the fuel tanks attached to the watercraft and used exclusively in watercraft motors.

††††† (4) Revenue Form 72A010, Motor Fuel Tax Refund Permit Holderís Bond, shall be used by an approved surety to establish surety obligation upon the payment of all taxes, penalties, and fines for which the designated refund applicant may become liable under KRS 138.344 to 138.355.

††††† (5) Revenue Form 72A011, Petroleum Storage Tank Environmental Assurance Fee Monthly Report, shall be used by licensed gasoline or special fuels dealers to report and remit monthly petroleum storage tank environmental assurance fee amounts due.

††††† (6) Revenue Form 72A052, Kentucky Motor Fuels Tax Refund Permit, shall be used by the Department of Revenue to issue Kentucky Motor Fuels Tax Refund Permits.

††††† (7) Revenue Form 72A053-A, Application for Refund of Kentucky Motor Fuel Tax Paid on Nonhighway Motor Fuels, shall be used by Kentucky Motor Fuels Tax Refund Permit holders to apply for refund of Kentucky motor fuel tax paid on nonhighway motor fuel.

††††† (8) Revenue Form 72A065, Aviation Gasoline Tax Refund Bond, shall be used by an approved surety to establish surety obligation upon the payment to the Commonwealth of any refunds to which the aviation gasoline refund applicant was not entitled.

††††† (9) Revenue Form 72A066, Application for Refund of Kentucky Tax Paid on Gasoline Used in Operation of Aircraft, shall be used by an aviation gasoline refund applicant to make application for refund of Kentucky tax paid on gasoline used in operation of aircraft.

††††† (10) Revenue Form 72A067, Application for Approval to Receive a Refund of Aviation Motor Fuels, shall be used by aviation gasoline tax refund applicants seeking approval to receive a refund of aviation gasoline tax.

††††† (11) Revenue Form 72A071, Motor Fuels Tax Refund Bond (City and Suburban Bus, Nonprofit Bus, Senior Citizen Transportation, or Taxicabs), shall be used by a surety company authorized to do business in Kentucky to establish surety obligation upon the payment to the Commonwealth of any refunds to which a city and suburban bus, nonprofit bus, senior citizen transportation, or taxicab refund applicant was not entitled.

††††† (12) Revenue Form 72A072, Application for Motor Fuel Refund - City and Suburban Bus Companies, Nonprofit Bus Companies, Senior Citizen Transportation, and Taxicab Companies, shall be used by refund applicants to make application for refund of Kentucky tax paid on fuel used in the operation of city and suburban bus companies, nonprofit bus companies, senior citizen transportation, and taxicab companies.

††††† (13) Revenue Form 72A073, Application for Approval to Receive a Refund of Tax on Motor Fuels Consumed by City and Suburban Buses, Nonprofit Buses, Senior Citizen Transportation and Taxicabs, shall be used by qualifying applicants to make application for approval to receive a refund of tax on motor fuels consumed by city and suburban buses, nonprofit buses, senior citizen transportation, and taxicabs.

††††† (14) Revenue Form 72A078, Statement of Claim for Accountable Loss of Motor Fuel, shall be used by licensed gasoline or special fuels dealers to make claim for accountable loss of motor fuel.

††††† (15) Revenue Form 72A089, Licensed Gasoline Dealer's Monthly Report, shall be used by licensed gasoline dealers to report and remit monthly gasoline tax.

††††† (16) Revenue Form 72A098, Transporterís Report of Motor Fuel Delivered, shall be used by licensed transporters to report a summation of monthly motor fuel deliveries.

††††† (17) Revenue Form 72A099, Transporterís Report, shall be used by licensed transporters to report monthly motor fuel deliveries.

††††† (18) Revenue Form 72A110, Certification of Motor Fuels Nonhighway Use, shall be used by qualifying entities to certify the nonhighway use of special fuels. The certification shall be maintained by the licensed special fuels dealer.

††††† (19) Revenue Form 72A135, Application for Kentucky Motor Fuels Tax Refund Permit, shall be used by a person desiring to qualify for a refund of motor fuel excise tax paid for nonhighway use.

††††† (20) Revenue Form 72A138, Licensed Special Fuels Dealerís Monthly Report, shall be used by a licensed special fuels dealer to report the total special fuels gallons received and distributed for a specific monthly period.

††††† (21) Revenue Form 72A161, Monthly Report Liquefied Petroleum Gas Dealer, shall be used by a licensed liquefied petroleum gas dealer to report all gallons of liquefied petroleum gas dispensed into the fuel tanks of licensed motor vehicles for a specific monthly period.

††††† (22) Revenue Form 72A170, Monthly Terminal Report, shall be used by a licensed motor fuels dealers to summarize all Kentucky terminal receipt and disbursement activity for a specific monthly period.

††††† (23) Revenue Form 72A178, Distributorís Schedule of Disbursements, shall be used by motor fuels dealers to report all disbursements for a specific monthly period.

††††† (24) Revenue Form 72A179, Distributorís Schedule of Receipts, shall be used by gasoline and special fuels dealers to report all receipts for a specific monthly period.

††††† (25) Revenue Form 72A180, Schedule 15A-Terminal Operator Schedule of Receipts, shall be used by gasoline and special fuels terminal operators to report all receipts for a specific monthly period.

††††† (26) Revenue Form 72A181, Schedule 15B-Terminal Operator Schedule of Disbursement, shall be used by gasoline and special fuels terminal operators to report all disbursements for a specific monthly period.

††††† (27) Revenue Form 72A300, Tax Registration Application for Motor Fuels License, shall be used by an applicant to register for a gasoline dealerís, special fuels dealerís, liquefied petroleum gas dealerís, motor fuel transporterís, or terminal owner-operatorís license.

††††† (28) Revenue Form 72A301, Motor Fuels License Bond, shall be executed by a corporation authorized to transact surety business in Kentucky on behalf of a licensee to insure payment of taxes, penalties, and interest for which a dealer or transporter may become liable.

††††† (29) Revenue Form 72A302, Motor Fuels License, shall be used by the Department of Revenue to issue a license to the qualified applicant in gasoline, special fuels, motor fuels transporter, or liquefied petroleum gas dealer.

††††† (30) Revenue Form 72A303, Election Application/Cancellation Form, shall be used by gasoline and special fuels dealers to elect to pledge a financial instrument other than a corporate surety bond.

††††† (31) Revenue Form 72A304, Motor Fuel Tax Electronic Filing Application, shall be used by motor fuels dealers to choose an electronic filing method.

 

††††† Section 10. Motor Vehicle Usage Tax - Required Forms. (1) Revenue Form 71A010, Motor Vehicle Usage Tax - Vehicle Condition Refund Application, shall be used by a taxpayer to apply for a refund of motor vehicle usage tax paid under KRS 138.450(16) based on the condition of the vehicle.

††††† (2) Revenue Form 71A100, Affidavit of Total Consideration Given for a Motor Vehicle, shall be presented to the county clerk to establish taxable value upon the first registration or transfer of a motor vehicle for motor vehicle usage tax purposes.

††††† (3) Revenue Form 71A101, Motor Vehicle Usage Tax Multi-Purpose Form, shall be presented to the county clerk by a vehicle owner to:

††††† (a) Claim one (1) of several exemptions;

††††† (b) Establish retail price if prescribed by the department; or

††††† (c) Establish retail price of new vehicles with equipment or adaptive devices added to facilitate or accommodate handicapped persons.

††††† (4) Revenue Form 71A102, Questionnaire, shall be completed by selected motor vehicle buyers and sellers providing specific information regarding a vehicle transaction.

††††† (5) Revenue Form 71A174, County Clerkís Adjusted Recapitulation of Motor Vehicle Usage Tax - Weekly Report, shall be submitted to the Department of Revenue by a county clerk as a recapitulation form to list all motor vehicle usage tax receipts, adjusted for corrections and commissions for a given week.

††††† (6) Revenue Form 71A174-A, County Clerkís Recapitulation of Motor Vehicle Usage Tax - Interim Report, shall be submitted to the Department of Revenue by a county clerk to report motor vehicle usage tax collections if an extension of time to file the computer generated weekly recapitulation report is requested.

††††† (7) Revenue Form 71F004, Motor Vehicle Usage Tax - Loaner-Rental Program, shall be used by motor vehicle dealers for instructions on how to register for the Loaner-Rental Program and file monthly reports.

††††† (8) Revenue Form 73A054, Kentucky Application For Dealer Loaner/Rental Vehicle Tax, shall be used by motor vehicle dealers to register to participate in the Loaner/Rental Vehicle Tax program.

††††† (9) Revenue Form 73A055, Monthly Report For Dealer Loaner/Rental Vehicle Tax, shall be used by motor vehicle dealers to report tax due on vehicles dedicated for use in the Loaner/Rental Vehicle Tax program.

††††† (10) Revenue Form 73A070, Motor Vehicle Usage Tax Request for Extension of Reports, Deposit and/or ACH Call-in, shall be used by county clerks for extension of daily deposits, daily ACH call-ins or weekly reports.

 

††††† Section 11. Racing Taxes - Required Form. (1) Revenue Form 73A100, Race Track Pari-Mutuel and Admissions Report, shall be used by race tracks licensed by the Kentucky Horse Racing Commission to report liability for the pari-mutuel tax and to report admissions to the race track.

††††† (2) Revenue Form 73A101, Historical Pari-Mutuel Report, shall be used by race tracks licensed by the Kentucky Horse Racing Commission to report tax liability for pari-mutuel wagering on historical racing.

††††† (3) Revenue Form 73A102, Advanced Deposit Wagering Excise Tax Report, shall be used by all advanced deposit account wagering licensees to report tax liability of amounts wagered through the licensee by Kentucky residents.

 

††††† Section 12. Transient Room Tax - Required Form. Revenue Form 73A850, Transient Room Tax Monthly Return, shall be used by all persons, companies, corporations, groups or organizations doing business as motor courts, motels, hotels, inns, tourist camps, or like or similar accommodations businesses (excluding campgrounds) to report the taxable rent amount and transient room tax liability.

 

††††† Section 13. Utility Gross Receipts License Tax - Required Forms. (1) Revenue Form 73A901, Utility Gross Receipts License Tax Return, shall be used by UGRLT account number holders to report total gross receipts, school district allocation, and tax liability.

††††† (2) Revenue Form 73A901(I), Instructions for Utility Gross Receipts License Tax Return, shall be used by UGRLT account number holders to complete the Utility Gross Receipts License Tax Return.

††††† (3) Revenue Form 73A902, Utility Gross Receipts License Tax (UGRLT) Energy Exemption Annual Return, shall be used by UGRLT account number holders to apply for an exemption from the utility gross receipts license tax.

††††† (4) Revenue Form 73F010, Utility Gross Receipts License Tax, shall be used by utility providers, Energy Direct Pay (EDP) holders, and consumers for instruction on how to register and file monthly reports.

 

††††† Section 14. Waste Tire Tax - Required Form. Revenue Form 73A051, Motor Vehicle Tire Fee Report, shall be used by businesses making retail sales of new motor vehicle tires to report liability for motor vehicle tire fees and to report the number of waste tires received from customers.

 

††††† Section 15. Incorporation by Reference. (1) The following material is incorporated by reference:

††††† (a) Alcoholic beverage tax - referenced material:

††††† 1. Revenue Form 73A504, "Acknowledgment of Tax Liability on Imported Alcoholic Beverages", July 2015;

††††† 2. Revenue Form 73A525, "Monthly Report of Distillers, Rectifiers or Bottlers", November 2007;

††††† 3. Revenue Form 73A526, "Wholesalerís Monthly Distilled Spirits Tax Report", January 2007;

††††† 4. Revenue Form 73A527, "Wholesalerís List of Individual Spirits Shipments Acquired", February 2011;

††††† 5. Revenue Form 73A529, "Consignorís Report of Alcoholic Beverages Shipped", January 2007;

††††† 6. Revenue Form 73A530, "Consignorís Report of Alcoholic Beverages Shipped", August 2014;

††††† 7. Revenue Form 73A531, "Transporterís Report of Alcoholic Beverages Delivered", January 2007;

††††† 8. Revenue Form 73A535, "Report of Destruction of Alcoholic Beverages", February 2011;

††††† 9. Revenue Form 73A575, "Wholesalerís Monthly Wine Tax Report", July 2015;

††††† 10. Revenue Form 73A576, "Vintnerís Wine Report", July 2015;

††††† 11. Revenue Form 73A577, "Wholesalerís List of Individual Wine Shipments Acquired", February 2011;

††††† 12. Revenue Form 73A626, "Brewerís Monthly Report Schedule", February 2011;

††††† 13. Revenue Form 73A627, "Beer Distributorís Monthly Report", February 2011;

††††† 14. Revenue Form 73A628, "Distributorís Monthly Malt Beverage Wholesale Sales Tax and Excise Tax Report", July 2015;

††††† 15. Revenue Form 73A628(I), "Instructions for Distributorís Monthly Malt Beverage Wholesale Sales Tax and Excise Tax Report", July 2015;

††††† 16. Revenue Form 73A629, "Beer Distributorís Sales to Federal Agencies", November 2006; and

††††† 17. Revenue Form 73A630, "Microbrewerís Retail Gross Receipts Report to Distributor", July 2015;

††††† (b) Bank franchise tax - referenced material:

††††† 1. Revenue Form 73A800, "Kentucky Registration Application for Bank Franchise Tax", January 2016;

††††† 2. Revenue Form 73A801(P), "2015 Kentucky Bank Franchise Tax Forms and Instructions", January 2016;

††††† 3. Revenue Form 73A801, "Bank Franchise Tax Return", January 2016; and

††††† 4. Revenue Form 73A802, "Application for 90-Day Extension of Time to File Kentucky Bank Franchise Tax Return", January 2016;

††††† (c) Cigarettes and Tobacco tax - referenced material:

††††† 1. Revenue Form 73A181, "Application for Cigarette and Tobacco Products Licenses", June 2013;

††††† 2. Revenue Form 73A190, "Cigarette and Tobacco Products License", July 2015;

††††† 3. Revenue Form 73A404, "Cigarette Tax Stamps Order Form", September 2014;

††††† 4. Revenue Form 73A406, "Cigarette Tax Credit Certificate", March 2009;

††††† 5. Revenue Form 73A409, "Cigarette Evidence/Property Receipt", November 2003;

††††† 6. Revenue Form 73A420, "Monthly Report of Cigarette Wholesaler", February 2012;

††††† 7. Revenue Form 73A420(I), "Instructions for Monthly Report of Cigarette Wholesaler", February 2012;

††††† 8. Revenue Form 73A421, "2009 Inventory Floor Tax for Cigarettes, Other Tobacco Products (OTP), and Snuff for Inventories as of March 31, 2009", March 2009;

††††† 9. Revenue Form 73A421A, "2009 Inventory Floor Tax for Cigarettes, Other Tobacco Products (OTP), and Snuff", March 2009;

††††† 10. Revenue Form 73A421B, "2009 Inventory Floor Tax for Cigarettes, Other Tobacco Products (OTP), and Snuff", March 2009;

††††† 11. Revenue Form 73A421W, "2009 Inventory Floor Tax for Cigarettes, Other Tobacco Products (OTP), and Snuff", March 2009;

††††† 12. Revenue Form 73A422, "Monthly Report of Tobacco Products, Snuff, and Chewing Tobacco", August 2013;

††††† 13. Revenue Form 73A422(I), "Instructions for Monthly Report of Tobacco Products, Snuff, and Chewing Tobacco", August 2013;

††††† 14. Revenue Form 73A450, "Retail Tobacco Inspection Report", August 2014; and

††††† 15. Revenue Form 73B401, "Cigarette Tax Credit Claim Wholesalerís Affidavit", March 2009;

††††† (d) Health care provider tax - referenced material:

††††† 1. Revenue Form 73A060, "Health Care Provider Tax Return", November 2008;

††††† 2. Revenue Form 73A060(I), "Instructions - Kentucky Health Care Provider Tax Return", August 2014; and

††††† 3. Revenue Form 73A061, "Kentucky Health Care Provider Application for Certificate of Registration", December 2006;

††††† (e) Inheritance tax - referenced material:

††††† 1. Revenue Form 92A121, "Acceptance of Inheritance and Estate Tax Return", July 2010;

††††† 2. Revenue Form 92A200, "Kentucky Inheritance Tax Return", June 2015;

††††† 3. Revenue Form 92A200P, "Kentucky Inheritance and Estate Tax Forms and Instructions", June 2015;

††††† 4. Revenue Form 92A201, "Kentucky Inheritance Tax Return No Tax Due", March 2012;

††††† 5. Revenue Form 92A204, "Real Estate Valuation Information Form", March 2012;

††††† 6. Revenue Form 92A205, "Kentucky Inheritance Tax Return (Short Form)", June 2015;

††††† 7. Revenue Form 92A300, "Affidavit of Exemption", September 2013;

††††† 8. Revenue Form 92A928, "Election to Defer the Payment of Inheritance Tax Through Installments", June 2015;

††††† 9. Revenue Form 92A929, "Notice of Agricultural and Horticultural Inheritance Tax Lien", March 1991;

††††† 10. Revenue Form 92A930, "Certificate of Release of Agricultural and Horticultural Inheritance Tax Lien", March 1990;

††††† 11. Revenue Form 92A931, "Certificate of Partial Discharge of the Agricultural and Horticultural Inheritance Tax Lien", July 1983;

††††† 12. Revenue Form 92A932, "Receipt of Inheritance and Estate Taxes", March 2008;

††††† 13. Revenue Form 92A936, "Election to Qualify Terminable Interest Property and/or Power of Appointment Property", March 2012;

††††† 14. Revenue Form 92F001, "Inheritance Tax Lien Releases and Inventory of Safe Deposit Boxes", March 2012; and

††††† 15. Revenue Form 92F101, "A Guide to Kentucky Inheritance and Estate Taxes", July 2014;

††††† (f) Insurance tax - referenced material:

††††† 1. Revenue Form 74A100, "Insurance Premiums Tax Return", January 2016;

††††† 2. Revenue Form 74A101, "Insurance Premiums Tax Return - Domestic Mutual, Domestic Mutual Fire or Cooperative and Assessment Fire Insurance Companies", January 2014;

††††† 3. Revenue Form 74A105, "Unauthorized Insurance Tax Return", January 2016;

††††† 4. Revenue Form 74A106, "Insurance Premiums Tax Return - Captive Insurer", January 2015;

††††† 5. Revenue Form 74A110, "Kentucky Estimated Insurance Premiums Tax for Calendar Year 2016", January 2016;

††††† 6. Revenue Form 74A116, "Tax Election for Domestic Life Insurance Companies", December 1998;

††††† 7. Revenue Form 74A117, "Monthly Insurance Surcharge Report - Domestic Mutual, Cooperative and Assessment Fire Insurer", January 2015;

††††† 8. Revenue Form 74A117A, "Insurance Surcharge Report Ė Domestic Mutual, Cooperative and Assessment Fire Insurer", January 2016;

††††† 9. Revenue Form 74A118, "Monthly Insurance Surcharge Report", January 2015; and

††††† 10. Revenue Form 74A118A, "Insurance Surcharge Report", January 2016;

††††† (g) Legal process - referenced material:

††††† 1. Revenue Form 73A200, "County Clerkís Monthly Report of Legal Process Tax Receipts", November 2006; and

††††† 2. Revenue Form 73A201, "Quarterly Report of Affordable Housing Trust Fund Fee", June 2006;

††††† (h) Marijuana and controlled substance - referenced material:

††††† 1. Revenue Form 73A701, "Instructions for Affixing Marijuana and Controlled Substance Tax Evidence (Stamp)", April 2011;

††††† 2. Revenue Form 73A702, "Notice of Tax Lien KRS 138.870 Marijuana and Controlled Substance Tax", April 2011; and

††††† 3. Revenue Form 73A703, "Marijuana or Controlled Substance Stamp Order Form", November 2006;

††††† (i) Motor fuels - referenced material:

††††† 1. Revenue Form 72A004, "Motor Fuels Tax Watercraft Refund Bond", August 2006;

††††† 2. Revenue Form 72A005, "Application for Approval to Sell Watercraft Refund Motor Fuels - Public Boat Dock", April 2009;

††††† 3. Revenue Form 72A006, "Motor Fuel Tax Refund Application - Public Boat Dock", December 2009;

††††† 4. Revenue Form 72A010, "Motor Fuel Tax Refund Permit Holderís Bond", October 2006;

††††† 5. Revenue Form 72A011, "Petroleum Storage Tank Environmental Assurance Fee Monthly Report", October 2006;

††††† 6. Revenue Form 72A052, "Kentucky Motor Fuels Tax Refund Permit", July 2007;

††††† 7. Revenue Form 72A053-A, "Application for Refund of Kentucky Motor Fuel Tax Paid on Nonhighway Motor Fuels", July 2007;

††††† 8. Revenue Form 72A065, "Aviation Gasoline Tax Refund Bond", October 2006;

††††† 9. Revenue Form 72A066, "Application for Refund of Kentucky Tax Paid on Gasoline Used in Operation of Aircraft", April 2009;

††††† 10. Revenue Form 72A067, "Application for Approval to Receive a Refund of Aviation Motor Fuels", April 2009;

††††† 11. Revenue Form 72A071, "Motor Fuels Tax Refund Bond (City and Suburban Bus, Nonprofit Bus, Senior Citizen Transportation, or Taxicabs)", October 2006;

††††† 12. Revenue Form 72A072, "Application for Motor Fuel Refund - City and Suburban Bus Companies, Nonprofit Bus Companies, Senior Citizen Transportation, and Taxicab Companies", August 2005;

††††† 13. Revenue Form 72A073, "Application for Approval to Receive a Refund of Tax on Motor Fuels Consumed by City and Suburban Buses, Nonprofit Buses, Senior Citizen Transportation, and Taxicabs", April 2009;

††††† 14. Revenue Form 72A078, "Statement of Claim for Accountable Loss of Motor Fuel", April 2011;

††††† 15. Revenue Form 72A089, "Licensed Gasoline Dealer's Monthly Report", July 2007;

††††† 16. Revenue Form 72A098, "Transporterís Report of Motor Fuel Delivered", July 2007;

††††† 17. Revenue Form 72A099, "Transporterís Report", July 2007;

††††† 18. Revenue Form 72A110, "Certification of Motor Fuels Nonhighway Use", April 2011;

††††† 19. Revenue Form 72A135, "Application for Kentucky Motor Fuels Tax Refund Permit", April 2009;

††††† 20. Revenue Form 72A138, "Licensed Special Fuels Dealerís Monthly Report", July 2007;

††††† 21. Revenue Form 72A161, "Monthly Report Liquefied Petroleum Gas Dealer", July 2007;

††††† 22. Revenue Form 72A170, "Monthly Terminal Report", July 2007;

††††† 23. Revenue Form 72A178, "Distributorís Schedule of Disbursements", July 2007;

††††† 24. Revenue Form 72A179, "Distributorís Schedule of Receipts" July 2007;

††††† 25. Revenue Form 72A180, "Schedule 15A-Terminal Operator Schedule of Receipts", July 2007;

††††† 26. Revenue Form 72A181, "Schedule 15B-Terminal Operator Schedule of Disbursement", July 2007;

††††† 27. Revenue Form 72A300, "Tax Registration Application for Motor Fuels License", April 2011;

††††† 28. Revenue Form 72A301, "Motor Fuels License Bond", October 2006;

††††† 29. Revenue Form 72A302, "Motor Fuels License", July 2007;

††††† 30. Revenue Form 72A303, "Election Application/Cancellation Form", September 2006; and

††††† 31. Revenue Form 72A304, "Motor Fuel Tax Electronic Filing Application", December 2007.

††††† (j) Motor vehicle usage tax - referenced material:

††††† 1. Revenue Form 71A010, "Motor Vehicle Usage Tax - Vehicle Condition Refund Application" April 2011;

††††† 2. Revenue Form 71A100, "Affidavit of Total Consideration Given for a Motor Vehicle", July 2014;

††††† 3. Revenue Form 71A101, "Motor Vehicle Usage Tax Multi-Purpose Form", April 2005;

††††† 4. Revenue Form 71A102, "Questionnaire", August 2000;

††††† 5. Revenue Form 71A174, "County Clerkís Adjusted Recapitulation of Motor Vehicle Usage Tax - Weekly Report", June 1991;

††††† 6. Revenue Form 71A174-A, "County Clerkís Recapitulation of Motor Vehicle Usage Tax - Interim Report", June 1991;

††††† 7. Revenue Form 71F004, "Motor Vehicle Usage Tax - Loaner-Rental Program", March 2006;

††††† 8. Revenue Form 73A054, "Kentucky Application for Dealer Loaner/Rental Vehicle Tax", August 2006;

††††† 9. Revenue Form 73A055, "Monthly Report for Dealer Loaner/Rental Vehicle Tax", January 2010; and

††††† 10. Revenue Form 73A070, "Motor Vehicle Usage Tax Request for Extension of Reports, Deposit and/or ACH Call-in", January 2009;

††††† (k) Racing taxes - referenced material:

††††† 1. Revenue Form 73A100, "Race Track Pari-Mutuel and Admissions Report", June 2015;

††††† 2. Revenue Form 73A101, "Historical Pari-Mutuel Report", June 2015;

††††† 3. Revenue Form 73A102, "Advanced Deposit Wagering Excise Tax Report", August 2014;

††††† (l) Transient room tax - referenced material: Revenue Form 73A850, "Transient Room Tax Monthly Return", January 2012;

††††† (m) Utility gross receipts license tax - referenced material:

††††† 1. Revenue Form 73A901, "Utility Gross Receipts License Tax Return", August 2005;

††††† 2. Revenue Form 73A901(I), "Instructions for Utility Gross Receipts License Tax Return", January 2006;

††††† 3. Revenue Form 73A902, "Utility Gross Receipts License Tax (UGRLT) Energy Exemption Annual Return", December 2008; and

††††† 4. Revenue Form 73F010, "Utility Gross Receipts License Tax", June 2011; and

††††† (n) Waste tire tax - referenced material: Revenue Form 73A051, "Motor Vehicle Tire Fee Report", May 2011.

††††† (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Department of Revenue, 501 High Street, Frankfort, Kentucky 40620, or at any Kentucky Department of Revenue Taxpayer Service Center, Monday through Friday, 8 a.m. to 5 p.m. (33 Ky.R. 3104; Am. 3354; eff. 6-1-2007; 35 Ky.R. 87; 764; eff. 10-31-2008; 36 Ky.R. 134; 560; eff. 10-2-2009; 37 Ky.R. 760; 7-1-2011; TAm 2-17-2016; 42 Ky.R. 2614, 2881, eff. 7-1-2016.)