I declare that the address listed is my place of domicile* or the place of domicile* of the Account Holder Name entered above, 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 true and correct as to every material matter.
