Kentucky Update or Cancellation of Kentucky Tax Account(s)

Update or Cancellation of Kentucky Tax Account(s)
Form 10A104
10A104 (04-25)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE

UPDATE OR CANCELLATION OF KENTUCKY TAX ACCOUNT(S)
FOR OFFICE USE ONLY

 Many of the updates on this form may be accomplished by completing a service
request on the mytaxes.ky.gov portal.

CRIS		

Coded / Entered / Date

 Incomplete or illegible updates will delay processing and will be returned.

Commonwealth Business Identifier (CBI)	

NAICS

 See instructions for questions regarding completion of this form.
 Need Help?  Call (502) 564-2694 or visit revenue.ky.gov.

SECTION A	

Federal Employer Identification Number (FEIN)

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, please visit mytaxes.ky.gov.

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________________________

SECTION B	

2. Effective Date of Change(s) Requested __ __/__ __/__ __ __ __
(mm/dd/yyyy)

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 FEIN to business record
 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

BUSINESS AND CONTACT INFORMATION (Must Be Completed)

3. Legal Business Name
NOTE:  All businesses organized or qualified with the Kentucky Secretary of State must first change their legal business name with
the Secretary of State before the Department of Revenue will update the legal business name associated with their tax accounts

4.

5.

Current Name 		

New Name (if applicable)

___________________________________________________ 	

____________________________________________________

___________________________________________________ 	

____________________________________________________

Doing Business As (DBA) Name
Current DBA

New DBA

___________________________________________________

____________________________________________________

Federal Employer Identification Number (FEIN)
(If applicable)

6. Kentucky Secretary of State Organization Number
(If applicable)

—
7.

Commonwealth Business Identifier (CBI)

8.

Person to Contact Regarding this Update Form:
Name (Last, First, Middle)	

Title	

Daytime Telephone	

(
E-mail: (By supplying your e-mail address you grant the Department
of Revenue permission to contact you via E-mail.)

)

Extension

– 

10A104 (04-25)	

Page 2

SECTION C	
9.

SALES AND USE TAX LOCATION INFORMATION

Update or Close an existing Business Location for your Sales and Use Tax Account.

CURRENT LOCATION ADDRESS INFORMATION


Close Location



Update/Move Location

NEW LOCATION ADDRESS INFORMATION

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	

County (if in Kentucky)	

(

Date Location Closed (mm/dd/yyyy)

Zip Code

City	

Location Telephone Number

)

State	

County (if in Kentucky)	

– 

(

Location Telephone Number

)

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	

County (if in Kentucky)	

Zip Code

Telephone Number

(

)

City	

State	

County (if in Kentucky)	

__ __/__ __/__ __ __ __

Zip Code

Telephone Number

– 

Description of Business Activity Performed at Location

SECTION D	

– 

__ __/__ __/__ __ __ __

10. - 11.	 Opened a new Location(s) of Current Business
NEW LOCATION ADDRESS

Date Location Opened (mm/dd/yyyy)

Zip Code

(
Date Location Opened (mm/dd/yyyy)

)

– 

__ __/__ __/__ __ __ __

Description of Business Activity Performed at Location

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)
 52/53 Week Calendar Year:

 Fiscal Year (year ending ___ ___/___ ___ (mm/dd))
 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 visit mytaxes.ky.gov.)
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 (04-25)	

Page 3

14.-15.	 OWNERSHIP DISCLOSURE—RESPONSIBLE PARTY UPDATE
Provide an end date and/or any other updated information for existing responsible parties and/or adding additional responsible
parties.
New Responsible Party





Update Existing



End Date

Full Legal Name (First, Middle, Last)

 New Responsible Party



Update Existing

End Date



Full Legal Name (First, Middle, Last)

Social Security Number (REQUIRED)	

FEIN (If Responsible Party is another business)

Social Security Number (REQUIRED)	

FEIN (If Responsible Party is another business)

Date of Birth	

Driver’s License State of Issuance & Number
(if applicable)

Date of Birth	

Driver’s License State of Issuance & Number
(if applicable)

Effective Date of Title (mm/dd/yyyy)

Business Title	

__ __/__ __/__ __ __ __

__ __/__ __/__ __ __ __

Business Title	

Effective Date of Title (mm/dd/yyyy)

__ __/__ __/__ __ __ __
Residence Address

City	

State	

Telephone Number	

County (if in Kentucky)

(

)

__ __/__ __/__ __ __ __
Residence Address

Zip Code

–  

City	

State	

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	

18. List New Mailing Address

__ __/__ __/__ __ __ __

c/o or Attn.

17. Tax Accounts for which the Address Change Applies
(Check all that apply)
 Employer’s Withholding Tax

 Consumer’s Use Tax

 Sales and Use Tax

 Corporation Income Tax
and/or Limited Liability
Entity Tax

 Motor Vehicle Tire Fee
 Commercial Mobile Radio
Service (CMRS) Prepaid
Service Charge Account

State	

County (if in Kentucky)	

Zip Code

Mailing Telephone Number

(

)

 – 

21. List New Mailing Address
c/o or Attn.

20. Tax Accounts for which the Address Change Applies
(Check all that apply)
 Employer’s Withholding Tax

 Consumer’s Use Tax

 Sales and Use Tax

 Corporation Income Tax
and/or Limited Liability
Entity Tax

 Commercial Mobile Radio
Service (CMRS) Prepaid
Service Charge Account

City	

 Pass-Through NonResident Withholding

__ __/__ __/__ __ __ __

 Motor Vehicle Tire Fee

	Address

 Coal Severance and
Processing Tax

19. Start Date for Additional Address Change

 Transient Room Tax

__ __/__ __/__ __ __ __

UPDATE MAILING ADDRESS AND PHONE NUMBERS FOR TAX ACCOUNTS

16. Start Date for Address Change

 Transient Room Tax

Zip Code

 Coal Severance and
Processing Tax
 Pass-Through NonResident Withholding

	Address

City	

State	

County (if in Kentucky)	

Zip Code

Mailing Telephone Number

(

)

 – 

10A104 (04-25)	

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
	 License Tax

  Corporation Income Tax
	 and/or Limited Liability
	 Entity Tax

  Coal Severance and
	 Processing Tax

23.	 REASON FOR CANCELLATION

	   Ceased having employees	
  Ceased making retail and/or
						 wholesale sales of tangible
	   Death of owner			 personal property or digital
						 property
	   Converted to another	
	 	
	 ownership type and must	
  Merged out of existence
			 reapply for new accounts			 (Complete Section #26 below)
	
	
  No further Kentucky activity			Other (Specify):
					
	
		 __________________________
	
		 __________________________

  Pass-Through Non	 Resident Withholding

  Commercial Mobile Radio
	 Service (CMRS) Prepaid
	 Service Charge Account

24.	 Effective Date to Cancel Account(s)

  Business closed/No	
  Business sold
	
	 further Kentucky activity			 (Complete Section #25 below)

	
	

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.

__ __/__ __/__ __ __ __

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

Printed Name:________________________________________________

Signature:___________________________________________________ 	

Signature:___________________________________________________

Title:_______________________________ Date:	 ____/____/______	

Title:_______________________________ Date:	 ____/____/______

	

Telephone Number:____________________________________________ 	

Telephone Number:___________________________________________

For assistance in completing the Update Form, please call the Data Quality Branch at (502) 564-2694, or you may use the Telecommunications
Device for the Deaf.
MAIL completed form to:	
	
	

KENTUCKY DEPARTMENT OF REVENUE	
501 HIGH STREET, STATION 20A
FRANKFORT, KENTUCKY 40601	

FAX:	
EMAIL:	

502-564-0796
[email protected]

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.

10A104-I (04-25)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE

INSTRUCTIONS

UPDATE OR CANCELLATION OF KENTUCKY TAX ACCOUNT(S)
This Form is used to update business information or request cancellation of an Employer’s Withholding Tax Account, Sales and Use Tax
Account,Transient Room Tax Account, Motor Vehicle Tire Fee Account, Telecommunications Tax Account, Utility Gross Receipts License
Tax Account, Commercial Mobile Radio Service (CMRS) Prepaid Service Charge Account, Consumer’s Use Tax Account, Corporation
Income Tax Account, Limited Liability Entity Tax Account, Coal Severance and Processing Tax Account, Coal Seller/Purchaser Certificate
ID Number and/or Pass-Through Non-Resident Withholding Tax Account.
For assistance in completing the Update Form, please call the Data Quality Branch at (502) 564-2694, or you may contact the
Telecommunications Device for the Deaf.
The Department of Revenue has an Ombudsman to serve as your advocate and is available to make sure your rights are protected.
You may contact the Ombudsman at (502) 564-7822.
SECTION A—REASON FOR COMPLETING THIS UPDATE FORM
 1.	

Current Kentucky Account Numbers—List the tax account(s)
assigned to your business or organization.

  2.	

Effective Date—Enter the effective date of the changes.

	

Check the box(es) which corresponds to the reason the form
is being submitted.
	•	
Update Business Name or DBA Name—Complete Sections
A and B to provide new name(s).

	
	

•	 Request Cancellation of an Account—If you need to
cancel an account, complete Sections A, B, and F.
•	 Closing Business / Close All Tax Accounts—If the
business is closing or all tax accounts need to be closed,
completed Sections A, B, and F.

SECTION B—BUSINESS AND CONTACT INFORMATION
  3.	

Legal Business Name—Enter the complete legal business
name for your business or organization. If you have changed
the name, enter the new name.
NOTE:  All businesses organized or qualified with the
Kentucky Secretary of State must have first changed their
legal business name with the Secretary of State before
the Department of Revenue will update the name on their
tax accounts.

	

•	 Update an Existing Business Location’s Information
for the Sales and Use Tax Account—Complete Sections
A, B, and C to provide the updated location information
for the Sales and Use tax account. An updated Sales
and Use Tax Permit will be sent for updated location.

	

	

•	 Close a Location of Current Business for the Sales
and Use Tax Account—Complete Sections A, B, and C
to provide the address information for the closing location.

  4.	 Doing Business As (DBA) Name—If your business or
organization has a “doing business as” name, enter the name.
If you have changed the DBA name, enter the new name.

	

•	 Open a New Location of Current Business for the Sales
and Use Tax Account—Complete Sections A, B, and C to
provide the new location information. A Sales and Use Tax
Permit will be sent for this new branch location.

  5.	

Federal Employer Identification Number (FEIN)—Enter the
FEIN assigned to your business or organization by the Internal
Revenue Service (IRS). If your FEIN has changed, an update
cannot be made. You must apply for new accounts by visiting
mytaxes.ky.gov.

  6.	

Kentucky Secretary of State Organization Number—Enter
the Organization Number assigned to your entity by the
Kentucky Secretary of State’s Office. (Sole Proprietorships
and General Partnerships are not required to register with the
Secretary of State.) If your Kentucky Organization Number has
changed, an update cannot be made. You must apply for new
account(s) by visiting mytaxes.ky.gov.

		

	

NOTE:  Taxpayers with different business locations
performing the same activity shall not be issued
separate sales tax accounts.

•	 Add FEIN to business record—Enter the FEIN assigned
to your business or organization by the Internal Revenue
Service (IRS) in Section B.
	

•	 Change Accounting Periods—Complete Sections A, B,
and D to notify the Department of Revenue of a change in
your Accounting Period year end.

  7.	

	

•	 Change Taxing Election—Complete Sections A, B, and
D to notify the Department of Revenue of a change in your
Taxing Election with the IRS.

Commonwealth Business Identifier (CBI)—Enter the
10-digit CBI Number that has been assigned to your business,
if applicable.

  8.	

	

•	 Update/Provide New Responsible Party Information—
Complete Sections A, B, and D to provide updated and/or
new responsible party information.

Person to Contact Regarding this Update Form—Enter the
name, title, daytime telephone number, extension and e-mail
address for the person to contact with questions about this
update form.

	

•	 Update Mailing Address(es)/Mailing Address Phone
Numbers—Complete Sections A, B, and E to update tax
account mailing address and/or phone number information.

10A104-I (04-25)	
SECTION C—SALES AND USE TAX LOCATION INFORMATION
  9.	

Update or Close an Existing Business Location—Select the
box to indicate Close Location or Update/Move Location. To
update an existing Business Location for your Sales and Use
Tax Account, list the old and new addresses for the location.
The location address must be the physical address of the
business location and not a P.O. Box address. (If you have
multiple locations to update, attach a separate listing of the
information in Question 9).

10. - 11.	Open a New Location of Current Business—List the
new address, telephone number, description of the activities
performed at the new location and the date the location will
open. The location address must be the physical address of
the business location and not a P.O. Box address. (If you have
more than two locations to add, attach a separate listing of the
information in Questions 10-11).
SECTION D—UPDATE ACCOUNTING PERIOD, OWNERSHIP TYPE,
AND/OR RESPONSIBLE PARTIES
12.	 Accounting Period Change with the IRS—Indicate the new
information if you have changed your Accounting Period with
the Internal Revenue Service (IRS).
13.	 Taxing Election Change with the IRS—
	
A.	 Enter your current Business Structure.
	
B.	 Indicate the old and new taxing elections.
14. - 15.	Ownership Disclosure—Responsible Party Update—
Enter the full legal name, Social Security Number or FEIN,
Date of Birth, Driver’s License State of Issuance and Number,
Business Title, Effective Date of Title, residence street
address, city, state, zip code, telephone number, and county
(if Kentucky).
	

NOTE:  You are required to provide your Social Security
Number on tax forms per Section 405, Title 42, of the
United States Code. This information will be used to
establish your identity for tax purposes.

	

If this responsible party will replace an existing responsible
party listed on your tax accounts, check the box and list the
previous responsible party’s name and the date they ceased
being in their listed title.

	

•	 For a Sole Proprietorship or an LLC (for Federal
Purposes Taxed as an Individual)—Enter the original
owner’s updated information. If there is a new owner,
updates cannot be made. You must apply for new accounts
by visiting mytaxes.ky.gov.

	

•	 For an LLC (for Federal Purposes Taxed as a Single
Member Disregarded Entity)—Enter the single member’s
updated company information in Question 16. If the LLC
has managers, their updated information can be entered
in Question 17. Attach a separate sheet for more LLC
managers.

	

•	 For a Joint Venture, General Partnership, Limited
Partnership, LLP, LLLP, or LLC (for Federal Purposes
Taxed as a Partnership, Corporation, S Corporation,
or Non–profit)—Enter the updated information for the
partners’/members’ information. If there are more than two
partners/members to update, attach a separate sheet.

Page 2
	

•	 For a Corporation, S Corporation, Government,
Association, REIT, RIC, REMIC, Trust or Non–profit—
Enter the updated officers’ information. If there are more
than two officers to update, attach a separate sheet.

SECTION E—UPDATE MAILING ADDRESS AND PHONE NUMBERS
FOR TAX ACCOUNTS
16.	 Start Date for Address Change—Enter the start date for the
mailing address change.
17.	 Tax Accounts for which the Address Change Applies—
Check the box(es) for all tax accounts for which the address
and/or phone number change applies.
18.	 List New Mailing Address—Complete the mailing address,
city, state, zip code, county if mailing address is in Kentucky,
and the telephone number for the address in this section. You
may include a PO Box here.
19.	 Start Date for Additional Address Change—If you have a
second address change for tax accounts other than the ones
checked in Question 16, enter start date for the mailing address
change.
20.	 Tax Accounts for which the Address Change Applies—
Check the box(es) for all tax accounts for which the second
address and/or phone number change applies.
21.	 List New Mailing Address—Complete the mailing address,
city, state, zip code, county if mailing address is in Kentucky,
and the telephone number for the second address in this
section. You may include a PO Box here.
SECTION F—REQUEST FOR CANCELLATION OF ACCOUNT(S)
22.	 Tax Accounts for which Cancellation is Requested—Check
the box(es) for the account(s) you wish to have cancelled.
23.	 Reason for Cancellation—Check the box that corresponds
to the reason the account should be cancelled. If “Other”
selected, enter reason.
24.	 Effective Date to Cancel Account(s)—Enter the last date of
operations or activity for the account type you are requesting
cancellation.
	

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.

25.	 If Business Sold—List the name, address and telephone
number for the new owners.
26.	 If Merged out of Existence—List the name, FEIN, address
and telephone number of the surviving business.