Transcription of Mailing Address (Number and Street including Apartment ...
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Mailing Address (Number and Street including Apartment ...
Example Do Not File Accepted version available on or before Jan. 1, 201942A805-K5 (6-14-18 DRAFT) Page 1 of 2 Kentucky Withholding Account Number Federal Employer Identification Number (FEIN)Business NameMailing Address (Number and Street including Apartment Number or Box) City, Town or Post Office State ZIP Code Telephone NumberKENTUCKYEMPLOYER S REPORT OFWITHHOLDING TAX STATEMENTS*180001 XXXX*2018K-5 Commonwealth of KentuckyDepartment of RevenueFORMPart I Kentucky withholding statement code and To:SignHerePaidPreparerUseSignature of Taxpayer DateName of Taxpayer TitleSignature of Preparer DateName of Preparer or Firm PTINE mail Telephone No. May the DOR discuss this return with this preparer? Ye s No Under penalties of perjury, I declare that I have examined this form and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
• 1099-R—Enter box 14, Kentucky Distribution, as Kentucky State Wages or Payments and box 12 for Kentucky income tax withheld. Only report Forms 1099 when Kentucky tax has been withheld.
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