KENTUCKY WEIGHT DISTANCE TAX FORM
KYU#
QTR Ending: 12/31/2005 Report all vehicles having a combined gross weight or licensed weight in excess of 59,999 pounds, excluding farm licensed vehicles.
Date Due: 01/31/2006 KY miles   x $ 0.0285 =
Amended Return
   Ceased Operations Address Change



If filed after due date Add 20% Penalty 
and 5 % Interest Per Annum. 
Total Penalty & Interest 
Total amount due 
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 stub.

 

Date:

TRANSPORTATION CABINET
DIVISION OF MOTOR CARRIERS
PO BOX 2004
FRANKFORT KY 40602-2004

Phone: 502-564-4150

 Person Completing Form:
   
Signature: ________________________
   
Phone #:
Format: 2223334444

Please print 2 copies of this page. Keep one to maintain for your records.
  

For overnight delivery, 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 stub.
  3. If submitting a previous quarter, highlight quarter ending.
  4. If checking one of the boxes above, highlight boxes checked.

Division of Motor Carriers Home Page

 

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.