Scribd Logo
Upload

Welcome to Scribd!

  • 15K views

    51A380 Form

    Uploaded by

    Jordan Mickle
    This document is a Declaration of Domicile form for Kentucky residents to claim an exemption from sales tax on residential utilities like water, sewer, gas, and electricity. It requires the account holder's name and service address and declares that address is the domicile of the resident signing. It requests the utility account be classified as tax exempt and understands that exemption will begin on the next full billing cycle after the provider receives the form. The resident signs under penalty of perjury that the information is true and provides instructions to submit the form to the utility provider rather than the Department of Revenue.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    51A380 Form

    Uploaded by

    Jordan Mickle
    15K views1 page
    This document is a Declaration of Domicile form for Kentucky residents to claim an exemption from sales tax on residential utilities like water, sewer, gas, and electricity. It requires the account holder's name and service address and declares that address is the domicile of the resident signing. It requests the utility account be classified as tax exempt and understands that exemption will begin on the next full billing cycle after the provider receives the form. The resident signs under penalty of perjury that the information is true and provides instructions to submit the form to the utility provider rather than the Department of Revenue.

    Original Description:

    51A380-Form

    Original Title

    51A380-Form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is a Declaration of Domicile form for Kentucky residents to claim an exemption from sales tax on residential utilities like water, sewer, gas, and electricity. It requires the account holder's name and service address and declares that address is the domicile of the resident signing. It requests the utility account be classified as tax exempt and understands that exemption will begin on the next full billing cycle after the provider receives the form. The resident signs under penalty of perjury that the information is true and provides instructions to submit the form to the utility provider rather than the Department of Revenue.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    15K views1 page

    51A380 Form

    Uploaded by

    Jordan Mickle
    This document is a Declaration of Domicile form for Kentucky residents to claim an exemption from sales tax on residential utilities like water, sewer, gas, and electricity. It requires the account holder's name and service address and declares that address is the domicile of the resident signing. It requests the utility account be classified as tax exempt and understands that exemption will begin on the next full billing cycle after the provider receives the form. The resident signs under penalty of perjury that the information is true and provides instructions to submit the form to the utility provider rather than the Department of Revenue.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    51A380 (1-23)

    Commonwealth of Kentucky DECLARATION OF DOMICILE FOR


    DEPARTMENT OF REVENUE PURCHASE OF RESIDENTIAL UTILITIES

    (LANDLORDS OR OTHER ACCOUNTHOLDERS OF MULTI-UNIT DWELLINGS SERVED BY A SINGLE METER


    (MASTER METER) USE THE MULTI-UNIT DECLARATION OF DOMICILE)

    In accordance with the provisions of KRS 139.470(7) this declaration may only be executed for the purchase of sewer
    services, water, and fuel by Kentucky residents for use in heating, water heating, cooking, lighting, and other residential
    uses. “Fuel” shall include but not be limited to natural gas, electricity, fuel oil, bottled gas, coal, coke, and wood.

    ___________________________________ is the accountholder for __________________________________________


    Name of Accountholder Service Address

    I,________________________________________________________________________________, am the resident or


    Name of Individual Signing the Declaration (cannot be landlord)

    ________________________________________________________________________________________________.
    Relationship of the undersigned to the resident

    I declare that the address listed is my place of domicile* or the place of domicile* of _____________________________
    Name of Resident

    and the purchase of residential utilities for use at this address meets the qualifications for exemption from Kentucky sales
    and use tax under KRS 139.470(7).

    Accordingly, I request the account associated with the above listed service address be classified as exempt from sales
    and use tax. I understand the exemption will begin on the date of the first full billing cycle after the date of receipt of this
    declaration by the utility provider or rural electric cooperative.

    Under penalties of perjury, I swear or affirm that the information on this declaration is true and correct as to every material
    matter.
    _________________________________________________
    Signature of resident or representative
    _________________________________________________
    Date

    * KRS 139.470(7) describes a place of domicile as “the place where an individual has his or her legal, true, fixed and
    permanent home and principal establishment, and to which, whenever the individual is absent, the individual has the
    intention of returning.”

    Instructions

    • Submit the Declaration of Domicile to each applicable utility provider or rural electric cooperative, not to the
    Department of Revenue.
    • Each resident may have only one place of domicile but may be listed as a responsible party for other service
    addresses.
    • The change in taxability for accounts will be effective on the first day of the first full billing cycle after the date of
    receipt of this declaration by the utility provider or rural electric cooperative.

    Department of Revenue Contact Information:

    Phone: 502-564-5170

    Email: [email protected]

    You might also like