Form Uz-5-Sb-A - Application For Exemption From Sales Tax On Purchases Of Goods And Materials For Exclusive Use Or Consumption Within An Urban Enterprise Zone
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1
2UZ-5-SB-A
STATE OF NEW JERSEY
3-07
DIVISION OF TAXATION
Application for Exemption from Sales Tax on Purchases of Goods and Materials for Exclusive Use or
Consumption within an Urban Enterprise Zone
1. Federal Employer I.D.#: __________________________________________
2. NJ Taxpayer ID #: ____ ____ ____ / ____ ____ ____ / ____ ____ ____ / ____ ____ ____
3. Name of Business (Individual, Partnership or Corporate Name) _____________________________________________________________________
Trade Name (if any) _______________________________________________________________________________________________________
Business Address _________________________________________________________________________________________________________
City _______________________________________________________
State ____________________
Zip Code ___________________
E-mail Address _________________________________________________________________________
4. Contact Name _________________________________________________________________________
5. Contact Telephone Number _______________________________________________________________
6. Contact E-mail Address __________________________________________________________________
7. Principal Product or Service ______________________________________________________________
8. UEZ File Number ______________________________________________________________________
9. Re-certification Beginning Date: ___________________________________ Re-certification Ending Date: ___________________________________
Please check the following boxes that pertain to your business and enter the requested information.
The business gross receipts from all locations of this business entity for the prior annual tax period were less than
$1 million. I am requesting that you certify the business listed above as a qualified small business and that you issue to
this business a UEZ-5-SB Exempt Purchase Certificate.
The information on the tax return indicated below reflects that the gross receipts of this business for the prior annual
tax period are $ ______________________________. These gross receipts are reported on:
Schedule A, Line 1 of my most recently filed NJ Corporation Business Tax Return (NJ-CBT100, NJ-CBT100S).
Line 1c of my IRS 1065 submitted with my most recently filed NJ Partnership Return (NJ-1065).
IRS Schedule C, Part 1, Line 3 submitted with my most recently filed NJ Gross Income Tax Return (NJ-1040)
Other - (e.g., foreign state tax return) ____________________________________________________________
The business gross receipts from all locations of this business entity for the prior annual tax period were $1 million or
more. I will be applying to the Division of Taxation for refunds of any use tax and/or sales tax paid at the point of
purchase for goods and materials for use or consumption exclusively within the zone.
I certify that I am authorized to complete this application; that it is true and complete; and I HEREBY CONSENT TO THE RELEASE OF TAX
INFORMATION OF THE APPLICANT BY THE DIVISION OF TAXATION TO THE UEZ AUTHORITY AND COORDINATORS AND THE NEW
JERSEY DIVISION OF REVENUE.
____________________________________________________________________________________________________________________________
Signature of Owner, Partner or Officer
Print or Type Name and Title
Date
,
,
,
THIS FORM MUST BE COMPLETED
SIGNED
AND RETURNED TO YOUR MUNICIPAL UEZ LOCAL COORDINATOR
ALONG WITH YOUR
-
APPLICATION FOR UEZ CERTIFICATION OR RE
CERTIFICATION
SEE INSTRUCTIONS ON REVERSE SIDE
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