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Application For Tax Credit For Contribution To A Community Development Corporation Form - City Of Philadelphia Department Of Revenue Page 3

City of Philadelphia

Department of Revenue

(8) Documentation that the Community Development Corporation will utilize the funds available under this tax credit

program to address at least one of the conditions of economic distress within a specified neighborhood within the

City of Philadelphia.

The neighborhood shall include the street boundaries and, where appropriate, river

boundaries.

(9) Attach an executed copy of the Community Development Corporation’s Certification of Compliance with all federal,

state, and city laws, ordinances, and resolutions and certification of non-indebtedness to the City of Philadelphia.

SECTION IV

Certification: To be signed by an authorized company representative.

I hereby certify that all information contained in this document and attachments are true and correct to the best of my

knowledge. If I knowingly make a false statement to obtain the tax credit for contribution to a community development

corporation, I

, may be subject to criminal

prosecution.

Company and Signer

Date:

Signature:

Print Name:

Representing:

Address:

Application For Tax Credit For Contribution To A Community Development Corporation Form - City Of Philadelphia Department Of Revenue Page 3