Kentucky K-1 Amended Employer's Return of Income Tax Withheld

K-1 Amended Employer's Return of Income Tax Withheld
Form 42A801(D)
42A801(D) (11-24)

Commonwealth of Kentucky
DEPARTMENT OF REVENUE

K-1

AMENDED EMPLOYER’S RETURN OF
INCOME TAX WITHHELD

FOR OFFICIAL USE ONLY

AMENDED RETURN

NAME AND ADDRESS

Period Beginning:
Period Ending:
Return Due:
Account No.:

A  As Originally
Reported or Adjusted
A  As Originally Reported or Adjusted  B  Correct Amount
Total Number of Employees This Period

EXPLANATION OF CHANGES

B  Correct
Amount

1. Total wages paid
this period...........
2. Kentucky income
tax withheld
this period...........
3. Previous period
adjustments or
	credits.................
4.	 Net tax due.........
5. Penalty (see
	instructions)........
6. Interest (see
	instructions)........
7. Total penalty
and interest
(line 5 plus
line 6)..................
8. Total amount due
(line 4 plus
line 7).................
  Credit forward to
  Refund requested $_______________  ________________________ period

I declare, under the penalties of perjury, that this return has been examined by me
and to the best of my knowledge and belief is a true, correct and complete return.

SIGN
HERE  	 _______________________	 _______________ 	 __________
SIGNATURE

TITLE

DATE

Remit total amount due. Make check payable to: Kentucky State Treasurer.
Mail to: Department of Revenue, Frankfort, Kentucky 40619.