Kentucky Update or Cancellation of Kentucky Tax Account(s)

Update or Cancellation of Kentucky Tax Account(s)
Form 10A104
10A104 (08-20)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE

UPDATE OR CANCELLATION OF KENTUCKY TAX ACCOUNT(S)
FOR OFFICE USE ONLY
CRIS		

Coded / Entered / Date

Commonwealth Business Identifier (CBI)	

NAICS

•	 Incomplete or illegible updates will delay processing and will be returned.
•

See instructions for questions regarding completion of this form.

•

Need Help?  Call (502) 564-2694 or visit www.revenue.ky.gov
Federal Employer Identification Number (FEIN)

SECTION A	

REASON FOR COMPLETING THIS UPDATE (Must Be Completed)

This Form may only be used to update current account information.
To apply for additional accounts or to reinstate previous account
numbers, use Form 10A100, Kentucky Tax Registration Application.

1. Current Account Numbers
Kentucky Employer’s Withholding Tax_____________________________
Kentucky Sales and Use Tax____________________________________
Kentucky Telecommunications Tax_______________________________
Kentucky Utility Gross Receipts License Tax________________________
Kentucky Consumer’s Use Tax__________________________________
Kentucky Corporation Income Tax and/or
	 Kentucky Limited Liability Entity Tax____________________________
Kentucky Coal Severance and Processing Tax______________________
Kentucky Pass-Through Non-Resident WH_________________________

SECTION B	

New Name (if applicable)

_________________________________________________________

_________________________________________________________________

_________________________________________________________

___________________________________________________________

Doing Business As (DBA) Name
Current DBA

New DBA

_________________________________________________________

5.

 /

Check all that apply.
 Update business name or DBA name
 Update an existing location’s information for the
Sales and Use Tax Account
 Close a location of current business for the Sales and Use Tax
Account
 Open a new location of current business for the Sales and Use
Tax Account
 Add a mine location to an existing Coal Tax Account
 Change accounting periods
 Change taxing election
 Update/provide new responsible party information
 Update mailing address(es) / mailing address telephone number(s)
 Request cancellation of an account
 Closing business / Close all tax accounts

BUSINESS AND CONTACT INFORMATION (Must Be Completed)

3. Legal Business Name
Current Name

4.

 /       

2. Effective Date

Federal Employer Identification Number (FEIN)
(Required, complete prior to submitting)

7.

Commonwealth Business Identifier (CBI)

8.

Person to Contact Regarding this Update Form:
Name (Last, First, Middle)	

_________________________________________________________________

6. Kentucky Secretary of State Organization Number
		
(If applicable)

Title	

Daytime Telephone	

(
E-mail: (By supplying your e-mail address you grant the Department
of Revenue permission to contact you via E-mail.)

)

Extension

– 

10A104 (08-20)	
	 SECTION C	

Page 2
SALES AND USE TAX LOCATION INFORMATION

9.	 Update or Close an existing Business Location for your Sales and Use Tax Account.
CURRENT LOCATION ADDRESS INFORMATION

NEW LOCATION ADDRESS INFORMATION

	 Business Location Name “Doing Business as” Name

	 Business Location Name “Doing Business as” Name

	 Street Address (DO NOT List a PO Box)

	 Street Address (DO NOT List a PO Box)

 Close Location     Update/Move Location

	 City	

State	

Zip Code

	

	 City	

State	

Zip Code

	

	 County (if in Kentucky)	

Location Telephone Number

(

)

	 County (if in Kentucky)	

Location Telephone Number

– 

(

)

– 

	 Date Location Closed (mm/dd/yyyy)
/	/	

		

10. - 11.	 Opened a new Location(s) of Current Business
NEW LOCATION ADDRESS

NEW LOCATION ADDRESS

	 Business Location Name “Doing Business as” Name

	 Business Location Name “Doing Business as” Name

	 Street Address (DO NOT List a PO Box)

	 Street Address (DO NOT List a PO Box)

	 City	

State	

Zip Code

	

State	

Zip Code

	

	 County (if in Kentucky)	

Telephone Number

(

)

	 County (if in Kentucky)	

Telephone Number

– 

	 Date Location Opened (mm/dd/yyyy)
		

	 City	

(

/	/	

		

– 

/	/	

	 Description of Business Activity Performed at Location

	 Description of Business Activity Performed at Location

	

	

	 SECTION D	

)

	 Date Location Opened (mm/dd/yyyy)

UPDATE ACCOUNTING PERIOD, OWNERSHIP TYPE, AND/OR RESPONSIBLE PARTIES

12.	 Accounting Period change with the Internal Revenue Service (IRS)
	
Accounting Period 	
	 Calendar Year (year ending December 31st) 	
	 Fiscal Year (year ending ___ ___/___ ___ (mm/dd))
			
	 52/53 Week Calendar Year:	
	 52/53 Week Fiscal Year:
				
December __________________________		
__________________________________________
					

(Day of Week that year ends)			

(Month & Day of Week that year ends)

13.	 Taxing Election Change with the IRS
	
(Note: If your Business Structure has changed, you are required to apply for new tax account numbers with the Department of
Revenue. Please complete Form 10A100, Kentucky Tax Registration Application.)
	

A.	 Current Business Structure ____________________________________________________________________

	

B.	 CURRENT TAXING ELECTION	

NEW TAXING ELECTION

	Partnership
 Corporation
 S-Corporation
 Cooperative
 Trust

	Partnership
 Corporation
 S-Corporation
 Cooperative
 Trust

  Single Member Disregarded Entity
	 (Member Federally Taxed as)
	   Individual Sole Proprietorship
	   General Partnership/Joint Venture
	  Estate
	   Trust (non-statutory)/Business Trust
	  Other_______________________________________

  Single Member Disregarded Entity
	 (Member Federally Taxed as)
	   Individual Sole Proprietorship
	   General Partnership/Joint Venture
	  Estate
	   Trust (non-statutory)/Business Trust
	  Other_______________________________________

10A104 (08-20)	

Page 3

14.-15.	 OWNERSHIP DISCLOSURE—RESPONSIBLE PARTY UPDATE
	
Provide updated information for existing responsible parties or add additional responsible parties.
  New Responsible Party    Update Existing    End Date

  New Responsible Party    Update Existing    End Date

	 Full Legal Name (First, Middle, Last)

	 Full Legal Name (First, Middle, Last)

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

	 Social Security Number	
FEIN (If Responsible Party is another
	 (REQUIRED)	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 (mm/dd/yyyy)

	 Business Title	

Effective Date of Title (mm/dd/yyyy)

/	/

	 	
	 Residence Address

/	/

	 	
	 Residence Address

	 City	

State	

Zip Code

	

	 City	

State	

Zip Code

	

	 Telephone Number	

(

)

County (if in Kentucky)

	 Telephone Number	

–  

(

)

County (if in Kentucky)

–  

	 Does this Responsible Party replace an existing one?

	 Does this Responsible Party replace an existing one?

	Yes    No  

	Yes    No  

	 Existing Responsible Party’s Name	

End Date (mm/dd/yyyy)

/	/

	 	

	 SECTION E	

	
17.	 Tax Accounts for which the Address Change Applies
	
(Check all that apply)
  Employer’s Withholding Tax

  Consumer’s Use Tax

  Sales and Use Tax

  Corporation Income Tax
	 and/or Limited Liability
	 Entity Tax

  Transient Room Tax
  Motor Vehicle Tire Fee
  Commercial Mobile Radio
	 Service (CMRS) Prepaid
	 Service Charge Account

	 c/o or Attn.
	Address
			
	 City	

  Pass-Through Non	 Resident Withholding

State	

Zip Code

	
	 County (if in Kentucky)	

  Coal Severance and
	 Processing Tax

19.	 Start Date for Address Change
	

Mailing Telephone Number

(

)

 – 

Note: To change the address or phone number for Telecommunications
Tax or Utility Gross Receipts License Tax, you must use the online system.
21.	 List New Mailing Address

 /         /

	
20.	 Tax Accounts for which the Address Change Applies
	
(Check all that apply)
  Employer’s Withholding Tax

  Consumer’s Use Tax

  Sales and Use Tax

  Corporation Income Tax
	 and/or Limited Liability
	 Entity Tax

  Commercial Mobile Radio
	 Service (CMRS) Prepaid
	 Service Charge Account

/	/

	 	

18.	 List New Mailing Address

 /         /

  Motor Vehicle Tire Fee

End Date (mm/dd/yyyy)

UPDATE MAILING ADDRESS AND PHONE NUMBERS FOR TAX ACCOUNTS

16.	 Start Date for Address Change
	

  Transient Room Tax

	 Existing Responsible Party’s Name	

  Coal Severance and
	 Processing Tax
  Pass-Through Non	 Resident Withholding

	 c/o or Attn.
	Address
			
	 City	

State	

Zip Code

	
	 County (if in Kentucky)	

Mailing Telephone Number

(

)

 – 

Note: To change the address or phone number for Telecommunications
Tax or Utility Gross Receipts License Tax, you must use the online system.

10A104 (08-20)	

Page 4

	 SECTION F	

REQUEST CANCELLATION OF ACCOUNT(S)

22.	 TAX ACCOUNTS FOR WHICH CANCELLATION IS REQUESTED
	
(Check all that Apply)
  Employer’s Withholding Tax

  Sales and Use Tax

  Consumer’s Use Tax

  Transient Room Tax

  Motor Vehicle Tire Fee

  Telecommunications Tax

  Utility Gross Receipts
	 License Tax

  Corporation Income Tax
	 and/or Limited Liability
	 Entity Tax

  Coal Severance and
	 Processing Tax

23.	 REASON FOR CANCELLATION

NOTE:	 A corporation’s or limited liability pass-through entity’s
income tax/LLET account number is cancelled with the filing of the
“final” return. A corporation or limited liability pass-through entity
organized in Kentucky shall not file a final return before it is officially
dissolved pursuant to the provisions of KRS Chapter 14A.

 /         /

24.	 Effective Date to Cancel Account(s)

  Business sold (See #25)

	   Ceased having employees	
  Ceased making retail and/or
						 wholesale sales of tangible
	   Death of owner			 personal property or digital
						 property
	   Converted to another	
	 	
	 ownership type and must	
  Merged out of existence
			 reapply for new accounts			 (See #26)
	
	
  No further Kentucky activity			Other (Specify):
					
	
		 __________________________
	
		 __________________________

  Pass-Through Non	 Resident Withholding

  Commercial Mobile Radio
	 Service (CMRS) Prepaid
	 Service Charge Account

  Business closed/No	
	
	 further Kentucky activity	

	
	

25.	 If business sold, list the information for the new owner(s).
	 Name

	 Name

	Address

	Address

	 City	

State	

Zip Code

	

	 City	

State	

Zip Code

	

		

Telephone Number

(

)

		

Telephone Number

– 

(

)

– 

26.	 If merged out of existence, list the information for the new business.
	Business Name

	 Address

	FEIN

	

	 Telephone Number

(

)

	 City	

– 

State	

Zip Code

	

IMPORTANT: THIS UPDATE FORM MUST BE SIGNED BELOW:
The statements contained in this Form 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 the Form.
Printed Name:_______________________________________________________ 	

Printed Name:_______________________________________________________

Signature:__________________________________________________________ 	Signature:__________________________________________________________
Title:_______________________________________ 	Date:	____/____/______	

Title:_______________________________________ 	 Date:	____/____/______

Telephone Number:___________________________________________________ 	

Telephone Number:___________________________________________________

For assistance in completing the Update Form, please call the Data Integrity Section at (502) 564-2694, or you may use the Telecommunications Device for the Deaf.
SEND completed form to:	
	
	

KENTUCKY DEPARTMENT OF REVENUE		
501 HIGH STREET, STATION 20A
FRANKFORT, KENTUCKY 40601		

FAX to:	

502-564-0796

EMAIL:	

[email protected]

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.