Kentucky Form 75A005, the Telecommunications Tax Complaint Form, is used by qualifying local government agencies to submit a complaint involving telecommunications-related tax distributions and the agency’s hold harmless amount. The form is designed for cities, counties, sheriffs, school districts, and special districts. It collects identifying information about the agency, the party against whom the complaint is filed, historical franchise fee amounts, the franchise portion of Public Service Commission property tax, payments received from the Kentucky Department of Revenue, and calculations comparing annualized distributions with the agency’s hold harmless amount. The form also gives the agency space to explain the factual basis of its complaint and to state whether the complaint involves a request for a substantial change connected with a franchise fee rate enacted or modified before June 30, 2005. Completing the calculations accurately is important because the figures are used to show whether the agency’s annualized payments are above or below the amount used for the hold harmless computation.
How To File Form 75A005
Complete both pages of the form and provide the requested calculations, contact information, complaint explanation, and authorized signature.
The completed form should be returned to:
Department of Revenue
ATTN: Local Distribution Fund Oversight Committee
P.O. Box 181
Frankfort, KY 40602-0181
Before beginning the form, gather:
- The agency’s official name and mailing address.
- The name, telephone number, and email address of the contact person.
- The agency’s Federal Employer Identification Number, or FEIN.
- The correct agency classification.
- The name of the party against whom the complaint is being filed.
- Franchise fee receipts for the fiscal year ending June 30, 2005.
- The franchise portion of applicable PSC property tax.
- Records of payments received from the Kentucky Department of Revenue.
- The number of payments received since January 2006.
- Documents or records supporting the complaint.
- Information concerning any franchise fee rate enacted or modified before June 30, 2005, if relevant to the complaint.
How To Complete Form 75A005
Agency Identification Information
Complete the identification portion at the top of the first page before working through the financial calculations.
Name And Mailing Address
Enter the complete name and mailing address of the entity submitting the complaint. Use the address where official correspondence concerning the complaint should be sent.
Contact Person
Enter the name of the individual who can answer questions about the complaint or provide additional information on behalf of the agency.
Phone Number
Enter a telephone number where the listed contact person can be reached.
E-mail Address
Enter the contact person’s email address for correspondence related to the complaint.
Agency
Enter the official name of the governmental agency submitting the form.
Federal Identification Number (FEIN)
Enter the agency’s Federal Employer Identification Number.
Agency Type
Check one box that accurately describes the agency submitting the complaint.
City
Check this box if the filing agency is a city. Enter the city’s name on the line provided.
County
Check this box if the filing agency is a county. Enter the county’s name.
Sheriff
Check this box if the complaint is being submitted by a sheriff’s office. Enter the appropriate name on the provided line.
School District
Check this box if the filing agency is a school district. Enter the school district’s name.
Special District
Check this box if the filing entity is a special district. Enter the name of that district.
Only one agency-type box should be selected.
Complaint Information
Name Of Party Against Whom Complaint Filed
Enter the full name of the person, organization, governmental entity, or other party that is the subject of the complaint.
Use the name that clearly identifies the party involved in the matter being disputed.
Fiscal Year Ending June 30, 2005 Franchise Fee Information
This section asks for franchise fee receipts that were certified to the Kentucky Department of Revenue for the fiscal year ending June 30, 2005.
Use the agency’s records for that fiscal year when completing lines 1 through 4.
Line 1: Telecommunications/Telephone Franchise Fees
Enter the total telecommunications or telephone franchise fee receipts that were certified to the Department of Revenue for the fiscal year ending June 30, 2005.
Report the dollar amount on line 1.
Line 2: Multichannel Video Programming/Cable Franchise Fees
Enter the total franchise fee receipts associated with multichannel video programming or cable services that were certified to the Department of Revenue for the same fiscal year.
Line 3: Public, Educational Or Governmental Fees (PEG Fees)
Enter the total Public, Educational, or Governmental fees included in the amounts certified to the Department of Revenue for the fiscal year ending June 30, 2005.
Line 4: Total Fees Certified To DOR
Add the applicable franchise fee amounts reported on lines 1, 2, and 3.
Enter the total amount of fees certified to the Department of Revenue on line 4.
Hold Harmless Amount
This section establishes the amount used for the form’s hold harmless comparison.
Line 5a: Total Franchise Fees Certified To DOR
Enter the amount from line 4 again on line 5a.
Do not recalculate the franchise fees separately. Line 5a carries forward the total already determined on line 4.
Line 5b: Franchise Portion Of PSC Property Tax
Enter the franchise portion of the applicable Public Service Commission property tax.
Use the amount supported by the agency’s records for the relevant fiscal-year calculation.
Line 6: Total Amount For FYE 6/05 For Hold Harmless Computation
Add line 5a and line 5b.
The calculation is:
Line 5a + Line 5b = Line 6
Enter the resulting amount on line 6. This is the fiscal-year-ending June 2005 total used for the hold harmless computation.
Distributions To Date
This section compares the agency’s historical hold harmless amount with payments it has received from the Kentucky Department of Revenue.
Line 7: Total Payments From DOR Received To Date
Enter the total dollar amount of payments the agency has received from the Kentucky Department of Revenue up to the date the complaint form is being prepared.
Review the agency’s payment records to make sure all relevant distributions are included.
Line 8: Number Of Payments Received Since January 2006
Enter the total number of payments the agency has received since January 2006.
This line asks for a number of payments, not a dollar amount.
Count the applicable payments carefully because this figure is used as the divisor in the annualization calculation on line 9.
Line 9: Total Payments Annualized
Calculate the annualized payment amount using the formula printed on the form:
Line 7 ÷ Line 8 × 12 = Line 9
First, divide the total payments reported on line 7 by the number of payments entered on line 8.
Then multiply that result by 12.
Enter the final annualized dollar amount on line 9.
Amount Over Or Under Hold Harmless
Line 10: Line 9 Total Minus Line 6 Total
Subtract the hold harmless amount on line 6 from the annualized payment amount on line 9.
Use this calculation:
Line 9 − Line 6 = Line 10
Enter the resulting amount on line 10.
The result represents the difference between the annualized payments calculated on line 9 and the hold harmless amount calculated on line 6. A positive or negative result should be reported as appropriate based on the calculation.
Signature And Certification
Complete the signature section at the bottom of the first page after reviewing the information and calculations.
Signature
The appropriate person completing or authorizing the complaint should sign the form in the space provided.
Title
Enter the signer’s official position or title.
Date
Enter the date on which the form is signed.
Complaint Explanation
The second page provides space for a written explanation supporting the complaint.
Narrative Explaining The Basis Of The Complaint
Provide a clear explanation of why the complaint is being submitted.
Describe the underlying issue, the relevant circumstances, and why the agency believes a review or adjustment is warranted.
The form permits the explanation to be written directly in the space provided or attached separately. If additional documentation is necessary to explain the complaint fully, include it with the filing.
The narrative should be consistent with the financial information entered on the first page and should make it possible to understand the specific issue being disputed.
Request For Substantial Change
The form contains an additional question concerning franchise fee rates.
Question: Does The Complaint Include A Request For Substantial Change Due To Enacting Or Modifying A Franchise Fee Rate Prior To June 30, 2005?
Determine whether the complaint requests a substantial change because a franchise fee rate was enacted or modified before June 30, 2005.
If the answer is yes, provide an explanation in the space below the question.
The explanation should identify the relevant franchise fee rate change and explain how that enactment or modification relates to the requested substantial change.
If this issue is not part of the complaint, do not create an explanation suggesting that it is.
Understanding The Main Calculation
The central calculation on Form 75A005 can be summarized as follows:
- Determine the total franchise fees certified for the fiscal year ending June 30, 2005.
- Add the franchise portion of PSC property tax to determine the hold harmless amount.
- Determine the total Department of Revenue payments received.
- Divide those payments by the number of payments received since January 2006.
- Multiply the result by 12 to obtain an annualized payment amount.
- Subtract the hold harmless amount from the annualized payments.
In formula form:
Total Certified Franchise Fees + Franchise Portion Of PSC Property Tax = Hold Harmless Amount
Then:
Total DOR Payments ÷ Number Of Payments × 12 = Annualized Payments
Finally:
Annualized Payments − Hold Harmless Amount = Amount Over Or Under Hold Harmless
These calculations correspond to lines 4 through 10 of the form.
Final Review Before Filing
Before submitting Form 75A005, verify the following:
- Confirm the agency’s name and mailing address.
- Make sure the contact person’s name, telephone number, and email address are correct.
- Verify the agency’s FEIN.
- Enter the official agency name.
- Check only the correct agency-type box.
- Enter the city, county, sheriff, school district, or special district name where required.
- Confirm the name of the party against whom the complaint is being filed.
- Verify the telecommunications or telephone franchise fee amount on line 1.
- Verify the cable or multichannel video programming franchise fee amount on line 2.
- Confirm the PEG fee amount on line 3.
- Recalculate the total certified fees on line 4.
- Make sure line 5a agrees with line 4.
- Verify the franchise portion of PSC property tax entered on line 5b.
- Confirm that line 6 equals lines 5a and 5b combined.
- Verify the total Department of Revenue payments entered on line 7.
- Confirm the number of payments entered on line 8.
- Recalculate line 9 using line 7 divided by line 8 and multiplied by 12.
- Confirm that line 10 equals line 9 minus line 6.
- Make sure the complaint narrative clearly explains the basis of the complaint.
- Answer the substantial-change question based on the circumstances of the complaint.
- If a substantial change is requested because of a franchise fee rate enacted or modified before June 30, 2005, provide the required explanation.
- Attach any additional narrative or supporting information needed to explain the complaint.
- Make sure the form is signed.
- Enter the signer’s title.
- Enter the signature date.
- Review both pages before submission.
- Send the completed form to the Department of Revenue, Attention: Local Distribution Fund Oversight Committee, at the mailing address provided on the form.