Form 10A104 PDF Details

The Commonwealth of Kentucky's form 10A104 represents a vital document for businesses required to update or cancel their Kentucky tax accounts. Managed by the Department of Revenue, it ensures that entities can efficiently handle changes in their business status, contact information, or operational scope—specifically regarding various state taxes such as the Employer's Withholding Tax, Sales and Use Tax, and several others. The form is designed to address updates ranging from changing business names (DBA), accounting periods, or responsible party information, to closing or adding new business locations. By facilitating these changes through the 10A104 form, the Kentucky Department of Revenue aids in maintaining accurate and current business records, ultimately supporting compliance with state taxation laws. Instructions included with the form guide businesses through its completion, while the note about contacting the Department for help underscores the state's commitment to assist taxpayers in their obligations. Additionally, the form acknowledges the necessity of providing updated contact information, thereby preventing delays in communication and ensuring businesses remain informed about their taxation status. This streamlined approach for submitting changes critically supports the state's economic structure by ensuring tax accountability and compliance.

QuestionAnswer
Form Name Ky 10A104 Form
Form Length 4 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 1 min
Other names 10A104611 ky 10a104 2011 form

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10A104 (08-20)

Commonwealth of Kentucky

UPDATE OR CANCELLATION OF KENTUCKY TAX ACCOUNT(S)

DEPARTMENT OF REVENUE

•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

FOR OFFICE USE ONLY

CRIS

Coded / Entered / Date

 

 

Commonwealth Business Identifier (CBI)

NAICS

 

 

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________________________

2. Effective Date

/

/

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

SECTION B

BUSINESS AND CONTACT INFORMATION (Must Be Completed)

3.

Legal Business Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Name

 

 

New Name (if applicable)

 

________________________________________________________

________________________________________________________________

 

________________________________________________________

__________________________________________________________

4.

Doing Business As (DBA) Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current DBA

 

 

New DBA

 

________________________________________________________

________________________________________________________________

5.

Federal Employer Identification Number (FEIN)

6. Kentucky Secretary of State Organization Number

 

(Required, complete prior to submitting)

 

(If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. Commonwealth Business Identifier (CBI)

8.Person to Contact Regarding this Update Form:

Name (Last, First, Middle)

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.)

10A104 (08-20)

Page 2

 

 

SECTION C

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

 

 

Close Location

Update/Move Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

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

 

City

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County (if in Kentucky)

 

 

Telephone Number

 

County (if in Kentucky)

 

 

 

Telephone Number

 

 

 

 

 

(

 

)

–

 

 

 

 

(

)

–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Location Opened (mm/dd/yyyy)

 

 

 

Date Location Opened (mm/dd/yyyy)

 

 

 

 

/

/

 

 

 

 

 

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description of Business Activity Performed at Location

 

 

 

Description of Business Activity Performed at Location

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION D

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

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 ______________________________________

NEW TAXING ELECTION

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 ______________________________________

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

Social Security Number

 

 

 

FEIN (If Responsible Party is another

 

(REQUIRED)

 

 

 

business)

 

 

 

 

(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)

 

 

Existing Responsible Party’s Name

 

 

End Date (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

/

 

 

 

 

 

 

 

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION E

 

 

UPDATE MAILING ADDRESS AND PHONE NUMBERS FOR TAX ACCOUNTS

 

 

 

 

 

16.Start Date for Address Change

//

17.Tax Accounts for which the Address Change Applies (Check all that apply)

18. List New Mailing Address

c/o or Attn.

Address

Employer’s Withholding Tax

Sales and Use Tax

Transient Room Tax

Motor Vehicle Tire Fee

Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account

19.Start Date for Address Change

Consumer’s Use Tax

Corporation Income Tax and/or Limited Liability Entity Tax

Coal Severance and Processing Tax

Pass-Through Non- Resident Withholding

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.

21. List New Mailing Address

/ /

20.Tax Accounts for which the Address Change Applies (Check all that apply)

c/o or Attn.

Address

Employer’s Withholding Tax

Sales and Use Tax

Transient Room Tax

Motor Vehicle Tire Fee

Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account

Consumer’s Use Tax

Corporation Income Tax and/or Limited Liability Entity Tax

Coal Severance and Processing Tax

Pass-Through Non- Resident Withholding

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

Corporation Income Tax

License Tax

and/or Limited Liability

 

Entity Tax

Coal Severance and

 

Processing Tax

Pass-Through Non-

 

Resident Withholding

Commercial Mobile Radio

 

Service (CMRS) Prepaid

 

23.REASON FOR CANCELLATION

Business closed/No further Kentucky activity

Ceased having employees

Death of owner

Converted to another ownership type and must reapply for new accounts

No further Kentucky activity

Business sold (See #25)

Ceased making retail and/or wholesale sales of tangible personal property or digital property

Merged out of existence (See #26)

Other (Specify):

_________________________

_________________________

Service Charge Account

24. Effective Date to Cancel Account(s)

/

/

 

 

 

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

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.

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: ______________________________________________________

Signature: _________________________________________________________

Title: ______________________________________ Date: ____/____/______

Telephone Number:__________________________________________________

Printed Name: ______________________________________________________

Signature: _________________________________________________________

Title: ______________________________________ Date: ____/____/______

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

FAX to:

502-564-0796

 

 

501 HIGH STREET, STATION 20A

 

 

 

 

FRANKFORT, KENTUCKY 40601

EMAIL:

DOR.WEBResponseDataIntegrity@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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Completing this PDF demands focus on details. Make sure that all required areas are completed properly.

1. When submitting the Ky 10A104 Form, be sure to complete all needed fields within its relevant area. This will help to facilitate the process, which allows your information to be handled quickly and properly.

Ky 10A104 Form conclusion process shown (step 1)

2. Once your current task is complete, take the next step – fill out all of these fields - Required complete prior to, Kentucky Secretary of State, If applicable, Commonwealth Business Identifier, Person to Contact Regarding this, Name Last First Middle, Title, Email By supplying your email, Daytime Telephone, and Extension with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Step no. 2 in filling in Ky 10A104 Form

Always be very mindful while filling in Extension and Commonwealth Business Identifier, because this is where many people make some mistakes.

3. This next stage is generally hassle-free - complete all the blanks in CURRENT LOCATION ADDRESS, UpdateMove Location, NEW LOCATION ADDRESS INFORMATION, Business Location Name Doing, Business Location Name Doing, Street Address DO NOT List a PO Box, Street Address DO NOT List a PO Box, City, County if in Kentucky, Date Location Closed mmddyyyy, State, Zip Code, Location Telephone Number, City, and County if in Kentucky to finish the current step.

Part # 3 for filling in Ky 10A104 Form

4. The next paragraph requires your details in the following areas: Date Location Opened mmddyyyy, Date Location Opened mmddyyyy, Description of Business Activity, Description of Business Activity, SECTION D, UPDATE ACCOUNTING PERIOD OWNERSHIP, Accounting Period change with the, Accounting Period, Calendar Year year ending, Day of Week that year ends, Fiscal Year year ending mmdd, Month Day of Week that year ends, Taxing Election Change with the, Note If your Business Structure, and A Current Business Structure. It is important to fill in all of the requested info to move forward.

Step no. 4 in filling out Ky 10A104 Form

5. To conclude your form, the final subsection incorporates a couple of extra blanks. Filling out Partnership Corporation, Partnership Corporation, Member Federally Taxed as, Single Member Disregarded Entity, Member Federally Taxed as, and Single Member Disregarded Entity will wrap up the process and you'll be done quickly!

Filling in segment 5 in Ky 10A104 Form

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