City Of Philadelphia Tax And Regulatory Status And Clearance Statement For Applicants printable pdf download

City Of Philadelphia Tax And Regulatory Status And Clearance Statement For Applicants

CITY OF PHILADELPHIA TAX AND REGULATORY

STATUS AND CLEARANCE STATEMENT

FOR APPLICANTS

THIS IS A CONFIDENTIAL TAX DOCUMENT NOT FOR PUBLIC DISCLOSURE

This form must be completed and returned with Applicant's proposal in order for Applicant to be eligible

for award ofa contract with the City. Failure to return this form will disqualify Applicant's proposal

from further consideration by the contracting department. Please provide the information requested in the

table, check the appropriate certification option and sign below:

Aoolicant Name

Contact Name and Title

Street Address

City, State, Zip Code

Phone Number

Federal Employer Identification Number or

Social Security Number:

Philadelphia Business Income and Receipts

Tax Account Number (f/k/a Business

Privilege Tax) {if none, state "none")•

Commercial Activity License Number (f/k/a

Business Privilege License) (if none, state

"none")*

I certify that the Applicant named above has all required licenses and permits and is current, or has

made satisfactory arrangements with the City to become current with respect to the payment of City taxes

or other indebtedness owed to the City (including, but not limited to, taxes collected by the City on behalf

of the School District of Philadelphia), and is not in violation, or has made satisfactory arrangements to

cure any violation, or other regulatory provisions applicable to Applicant contained in the Philadelphia

Code.

I certify that the Applicant named above does not currently do business, or otherwise have an

economic presence in Philadelphia. If Applicant is awarded a contract with the City, it promptly will take

all steps necessary to bring it into compliance with the City's tax and other regulatory requirements.

Date

Authorized Signature

Print Name and Title

• You can apply for a City of Philadelphia Business Income and Receipts Tax Account Number or a Commercial

Activity license on line after you have registered your business on the City's Business Services website located at

Click on "Register'' or "Register Now" to register your business.

City Of Philadelphia Tax And Regulatory Status And Clearance Statement For Applicants