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Kentucky Free Printable  for 2021 Kentucky Kentucky Individual Income Tax Installment Agreement Request

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Kentucky Individual Income Tax Installment Agreement Request
Form 12A200

GENERAL INSTRUCTIONS If you are unable to pay the full amount due with your individual income tax return, you may request an installment agreement by completing this form and attaching it to the front of your return. Specify the amount of the monthly payment you propose to make in the block marked “Proposed Monthly Payment Amount.” Payments should be as large as possible to lower penalty and interest charges. You can make installment payments in three ways. Credit cards or ACH Debits will save you the time and trouble of mailing monthly payments and may help save you additional penalties, interest or fees. • Pay by Credit Card—To charge your monthly payments to MasterCard, VISA, American Express or Discover provide the account number and other information on the form below. You must also provide the cardholder’s name and billing address exactly as it appears on the credit card billing statement. You may also arrange credit card installments by phone. For more information, call (502) 564-4921, ext. 5354. A convenience fee may apply to each monthly payment. Please indicate date for credit card payment. • Pay by ACH Debit—To request that your monthly payments be withdrawn electronically from a bank account, attach a voided check to the completed form below. You may also call (502) 564-4921, ext. 5354 to request this option. Please indicate date for ACH Debit payment. • Pay by Mail—Make your checks or money orders payable to the Kentucky State Treasurer. Include the taxpayer’s full name(s), Social Security number(s), and the tax period you are paying. Mail the payments to the Division of Collections, P.O. Box 491, Frankfort, KY 40602-0491. You will be advised if your request for an installment agreement is approved or denied. If you do not receive a response to this request within 90 days from the date you file your return, please call the Division of Collections, (502) 564-4921, ext. 5354. CUT HERE ✄   ATTACH THIS FORM TO THE FRONT OF YOUR RETURN 12A200 (11-13) DEPARTMENT OF REVENUE Taxpayer full name(s) as shown on return Taxpayer Social Security number Address City Home telephone number Convenient time to call (    ) Amount paid with return Amount you owe (Form 740, Form 740-EZ, Form 740-NP) $ $ by Credit Card  ➤ Type of credit card Spouse Social Security number State Pay by ACH Debit/Electronic Check  ➤ ZIP Code   Check if paying by ACH Debit (Attach voided check)   PROPOSED MONTHLY PAYMENT AMOUNT Amount I am able to pay each month $ Date of first payment Pay 2 0 _ _ KENTUCKY INDIVIDUAL INCOME TAX INSTALLMENT AGREEMENT REQUEST Date each month I am able to pay Credit card number Expiration date Name and address as it appears on card (if different from taxpayer) Cardholder’s signature Date Your signature/Spouse’s signature (joint or combined returns only) Date INDIVIDUAL INCOME TAX INSTALLMENT AGREEMENT REQUEST GENERAL INFORMATION A Kentucky taxpayer has the right to consideration of an installment agreement for the payment of delinquent taxes, interest, penalties and fees. The right to an installment agreement is provided for in KRS 131.081(9) and is primarily dependent on the taxpayer’s inability to pay the amount due in full. Setting up the Agreement Eligibility for an Installment Agreement State Tax Lien An installment agreement should be requested only when there is no other way of paying the liability on time. Depending on the amount and length of the agreement, a State Tax Lien may be filed. If a lien is filed, it will remain on the taxpayer’s credit record for up to seven years after the liability is paid and the lien is released. A taxpayer must clearly demonstrate an inability to pay the liability in full and the agreement must facilitate collection. Generally this means that taxpayers who have the ability to pay with available funds or borrow from a financial institution are not eligible. Proposed Monthly Payment Amount The monthly payment amount will be based upon the taxpayer’s ability to pay after considering the taxpayer’s monthly income and reasonable expenses. Allowable expenses generally include reasonable amounts for food, clothing, housing (and associated expenses), installment payments and other necessary living expenses. The proposed monthly payment amount should be as much as possible to minimize the length of the agreement and the accrual of interest, penalties and fees. Interest, Penalties, Fees and Refund Offsets The law provides for the assessment of interest, penalties and fees for tax liabilities paid after the due date. Interest accrues at the tax interest rate (6 percent for 2014). In addition, penalties of 2 percent per month may be assessed on the unpaid tax. A 25 percent Cost of Collection Fee is imposed on tax due which becomes due and payable (generally 46 days after the assessment date). Interest, penalties and fees continue to accumulate while an installment agreement is in place. Also, any money Kentucky may owe you (tax refunds, etc.) will be offset to your outstanding liability. Additionally, any federal income tax refund that may become due to you may be offset to this liability pursuant to 26 USC §6402(e). Penalties and fees may be waived or reduced if the taxpayer files the return on time, honors the payment agreement and/or demonstrates reasonable cause. Taxpayers who believe they qualify for an installment agreement should complete Form 12A200, Individual Income Tax Installment Agreement Request, and attach the form to the front of the return. Assistance Questions should be directed to: Division of Collections Kentucky Department of Revenue P.O. Box 491 Frankfort, KY 40602-0491 (502) 564-4921, ext. 5354 Form 12A200, Individual Income Tax Installment Agreement Reques t, is available at Kentuck y Taxpayer Service Centers located throughout the Commonwealth. Forms may also be obtained from the Internet at www.revenue.ky.gov, or by contacting the Division of Collections or by sending a written request to: FORMS Operations and Support Services Branches Kentucky Department of Revenue 501 High Street Frankfort, KY 40620 (502) 564-3658
Extracted from PDF file 2020-kentucky-form-12a200.pdf, last modified November 2013

More about the Kentucky Form 12A200 Individual Income Tax TY 2020

If you are unable to pay the full amount due with your individual income tax return, you may request an installment agreement by completing this form.

We last updated the Kentucky Individual Income Tax Installment Agreement Request in May 2021, so this is the latest version of Form 12A200, fully updated for tax year 2020. You can download or print current or past-year PDFs of Form 12A200 directly from TaxFormFinder. You can print other Kentucky tax forms here.

Other Kentucky Individual Income Tax Forms:

TaxFormFinder has an additional 129 Kentucky income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 740ES Estimated Income Tax Return
Form 740 Kentucky Individual Income Tax Return
Income Tax Instructions Form 740 Instructions
740-V Electronic Filing Payment Voucher
Form 740-NP Kentucky Individual Income Tax Return Nonresident or Part-Year Resident

Download all KY tax forms View all 130 Kentucky Income Tax Forms


Form Sources:

Kentucky usually releases forms for the current tax year between January and April. We last updated Kentucky Form 12A200 from the Department of Revenue in May 2021.

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About the Individual Income Tax

The IRS and most states collect a personal income tax, which is paid throughout the year via tax withholding or estimated income tax payments.

Most taxpayers are required to file a yearly income tax return in April to both the Internal Revenue Service and their state's revenue department, which will result in either a tax refund of excess withheld income or a tax payment if the withholding does not cover the taxpayer's entire liability. Every taxpayer's situation is different - please consult a CPA or licensed tax preparer to ensure that you are filing the correct tax forms!

Historical Past-Year Versions of Kentucky Form 12A200

We have a total of ten past-year versions of Form 12A200 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:



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