Form 41a720-Ci - Schedule Ci - Application For Coal Incentive Tax Credit

Form 41a720-Ci - Schedule Ci - Application For Coal Incentive Tax Credit - 2009

Schedule CI

For Coal Purchased

*0900010221*

During Calendar Year 20__ __

41A720-CI (10-09)

Commonwealth of Kentucky

DEPARTMENT OF REvENuE

PPlICATIon

oAl

nCEnTIvE

rEDIT

KrS 141.0405

➤ See instructions.

Name of Taxpayer

Federal Identification Number

__ __ — __ __ __ __ __ __ __

Number and Street

Kentucky Corporation/LLET Account Number

City

State

ZIP Code

Telephone Number (Include Area Code)

The Company:

Is an electric power company

Owns and operates a coal-fired electric generating plant

Owns and operates an alternative fuel facility or gasification facility

Type of Entity (check applicable box):

Corporation

Limited Liability Pass-through Entity

General Partnership

Municipal Electric Company

Other ➤

__ __ __ __ __ __

Kentucky Corporation/LLET Account Number (if applicable)

GNC Number

PArT I—Qualifying Tons of Coal Purchased During Base Year (Calendar Year 1999) and Used To Generate Electricity

Name and Kentucky Coal Severance Tax Account

For Department

Qualifying Tons of

Number of Taxpayer Subject to Kentucky

of revenue Use only

Name of Supplier

Coal Purchased

Coal Severance Tax On Qualifying Coal Purchases

Approved Tons Purchased

10.

11. Total Approved Tons for Base Year ....................................................................................................................

PArT II—Qualifying Tons of Coal Purchased During Calendar Year 20__ __ and Used to Generate Electricity

Name and Kentucky Coal Severance Tax Account

For Department of

Qualifying Tons of

Name of Supplier

Number of Taxpayer Subject to Kentucky

revenue Use only

Coal Purchased

Coal Severance Tax On Qualifying Coal Purchases

Approved Tons Purchased

10.

11. Total Approved Tons for Calendar Year 20__ __

I, the undersigned, declare under the penalties of perjury, that I have examined this application, including all accompanying schedules and statements,

and to the best of my knowledge and belief, they are true, correct and complete.

Signature of Principal Officer or Chief Accounting Officer

Date

Type Name and Title of Principal Officer or Chief Accounting Officer