51A291 (4-11)
Commonwealth of Kentucky
APPLICATION FOR
DEPARTMENT OF REVENUE
KENTUCKY SIGNATURE PROJECT
SALES AND USE TAX REFUND
Name
(
)
Enter Name of Approved Agency (please print or type)
Telephone Number (include area code)
Construction
Location
Number and Street
City or Town
State
ZIP Code
Mailing Address
(if different)
Number and Street
City or Town
State
ZIP Code
Contact
(
)
Contact Person
E-mail Address
Telephone Number (include area code)
REFUND REQUESTED $
REFUND PERIOD
(1)
Claims for refunds must be filed annually within 60 days following the end of the fiscal year in which the project grant is
executed and shall cover purchases made during the immediately preceding year. The final refund request shall be filed within
60 days following the end of the twelfth fiscal year in which the project grant agreement is in effect, or within 60 days after
construction is complete, whichever occurs first.
(2)
A refund can only be requested for Kentucky sales and use tax paid. No refund for sales tax paid to other states or localities
will be refunded.
(3)
In accordance with KRS 139.770, the amount of refund requested will be reduced by the amount of compensation taken
when the sales or use tax was paid or by the amount of any tax liability due the Commonwealth of Kentucky by the applicant.
If applicable, the refund will be reduced by any difference in the % of allowed expenditures, if different from the initial
estimate.
(4)
Interest shall not be allowed or paid on any refund.
(5)
Attach copies of the information-sharing agreements with contractors, vendors or other related parties to verify tangible
personal property used in the construction of a signature project.
(6)
Attach all expenditure reports (Form 51A292) to the refund application with copies of pertinent invoices (from each
vendor).
(7)
Mail completed application and supporting documentation to the Kentucky Department of Revenue, Division of Sales and
Use Tax, P. O. Box 181, Station 67, Frankfort, Kentucky 40602-0181.
Any questions can be directed to the Division of Sales and Use Tax at (502) 564-5170.
I, the undersigned, do declare under penalties of perjury that I have examined this application (including any accompanying statements or schedules
and reports), and to the best of my knowledge and belief, the information and statements regarding the refundable credit for sales and use tax paid on
purchases of building and construction materials purchased and used in the construction of the project contained herein are true, complete and correct,
and that I am duly authorized to sign this application. The undersigned certifies that no tax liability of any kind is due the Commonwealth of Kentucky
by this applicant.
Signed ______________________________________________________
Title ___________________________________________
Date _______________________________________________________
(Print or Type)