Sales Tax Exemption Form 电子邮件(Required) This Exemption Form is for:(Required) Primary Residence Exemption Landlord of Master Metered Property Only Primary Residence Exemption FormDECLARATION OF DOMICILE FOR PURCHASE OF RESIDENTIAL UTILITIES (LANDLORDS OR OTHER ACCOUNTHOLDERS OF MULTI-UNIT DWELLINGS SERVED BY A SINGLE METER (MASTER METER) USE THE MULTI-UNIT DECLARATION OF DOMICILE) In accordance with the provisions of KRS 139.470(7) this declaration may only be executed for the purchase of sewer 服务, 水, and fuel by Kentucky residents for use in heating, 水 heating, 烹饪, 照明, and other residential 使用. “Fuel” shall include but not be limited to natural gas, electricity, 燃油, bottled gas, 煤炭, 可口可乐, 和木材.Name of Account Holder 第一个 最后的 Service Address Street Address Address Line 2 城市 ZIP / Postal Code In relation to the above listed Serivce Address, I am: 居民 其他 If you are not the 居民 of the above Service Address, please indicate the nature of your relationship.I declare that the address listed is my place of domicile* or the place of domicile* of 第一个 最后的 and the purchase of residential utilities for use at this address meets the qualifications for exemption from Kentucky sales and use tax under KRS 139.470(7). Accordingly, I request the account associated with the above listed service address be classified as exempt from sales and use tax. I understand the exemption will begin on the date of the first full billing cycle after the date of receipt of this declaration by the utility provider or rural electric cooperative. Under penalties of perjury, I swear or affirm that the information on this declaration is 真正的 and correct as to every material 事.Signature of resident or representative 第一个 最后的 日期 MM slash DD slash YYYY * krs139.470(7) describes a place of domicile as “the place where an individual has his or her legal, 真正的, fixed and permanent home and principal establishment, and to which, whenever the individual is absent, the individual has the intention of returning.” Instructions Submit the Declaration of Domicile to each applicable utility provider or rural electric cooperative, not to the Department of Revenue. Each resident may have only one place of domicile but may be listed as a responsible party for other service addresses. The change in taxability for accounts will be effective on the first day of the first full billing cycle after the date of receipt of this declaration by the utility provider or rural electric cooperative. Department of Revenue Contact Information: 电话: 502-564-5170 电子邮件: DOR.Webresponsesalestax@ky.政府Landlord of Master Metered Property OnlyMULTI-UNIT DECLARATION OF DOMICILE FOR LANDLORDS OR OTHER ACCOUNT HOLDERS OF MULTI-UNIT DWELLINGS SERVED BY A SINGLE METER (MASTER METER)Number of DeclarationsUnder penalties of perjury, I swear or affirm that the above number of declarations I am submitting with this form include 100% of the dwelling units at the service address below.Address Street Address Address Line 2 城市 ZIP / Postal Code Number of Dwelling UnitsAccount Name Authorized Signature 第一个 最后的 日期 MM slash DD slash YYYY Instructions This Multi-Unit Declaration of Domicile is for landlords or other persons holding a single account with a utility provider or rural electric cooperative which serves multiple dwelling units. Submit the Multi-Unit Declaration of Domicile along with individual declarations for all dwelling units to each applicable utility provider or rural electric cooperative, not to the Department of Revenue. Landlords or other accountholders should submit a Multi-Unit Declaration of Domicile for each meter that serves multiple units; however, every unit served by the meter must have a fully-completed Declaration of Domicile for the account to qualify as residential. Landlords or other accountholders may not complete the Declaration of Domicile on behalf of their residents. Accounts for meters that exclusively serve common areas or that serve common areas and multiple dwelling units are not eligible for residential treatment. No declaration shall be submitted for these accounts. The change in taxability for accounts will be effective on the first day of the first full billing cycle after the date of receipt of this Multi-Unit Declaration of Domicile by the utility provider or rural electric cooperative. Department of Revenue Contact Information: 电话: 502-564-5170 电子邮件: DOR.Webresponsesalestax@ky.政府评论This field is for validation purposes and should be left unchanged.