KENTUCKY WEIGHT DISTANCE TAX FORM
KYU#
TC 95-101
 
Report all vehicles having a combined gross weight or licensed weight in excess of 59,999 pounds, excluding farm licensed vehicles.
QTR Ending:
09/30/2007
Miles: 
  X   $ 0.0285  =  
$0.00
Date Due:
10/31/2007
  
Amended return means that you have already submitted an original tax return and have made changes. Please check if this correct?
Ceased operations means you are no longer in business or no longer travel in Kentucky. Please check if this correct?
If filed after due date add 20%  penalty
$0.00
and 8 % interest per year.
$0.00

Total Penalty & Interest
$0.00
Is the above address correct?
Total Amount Due
$0.00
THIS REPORT WILL BE STORED IN AN ELECTRONIC FORMAT, PLEASE KEEP A COPY OF THE COMPLETED RETURN FOR A FIVE YEAR PERIOD.
Make check payable to: Kentucky State Treasurer.
Write quarter and KYU# on check and remove stub.
Date: 7/24/2008
Mail this report with remittance to:
TRANSPORTATION CABINET
DIVISION OF MOTOR CARRIERS
PO BOX 2004
FRANKFORT KY 40602-2004
Phone: 502-564-4150 		Person Completing Form:
 
Signature: ______________________
Phone #:
 
Please print 2 copies of this page. Keep one to maintain for your records.
If using overnight delivery services, please send to: Division of Motor Carriers, 200 Mero Street, Frankfort, KY 40622
Helpful hints/reminders
  1. Make sure the return is signed.
  2. Write quarter and KYU# on check and remove stub.
  3. If submitting a previous quarter, highlight quarter ending.
  4. If checking one of the boxes above, highlight boxes checked.
If you experience trouble completing the application, please contact the Division of Motor Carriers @ 502.564.4150 Monday-Friday between 8:00 and 4:30 EST.