Application For Job Creation Tax Credit - Pennsylvania Department Of Revenue printable pdf download

Application For Job Creation Tax Credit - Pennsylvania Department Of Revenue

City of Philadelphia

FOR DEPARTMENT USE ONLY

Application No. __________________

Department of Revenue

Date Received ___________________

Time Received ___________________

APPLICATION FOR JOB CREATION TAX CREDIT

(SECTION 19-2604 OF THE PHILADELPHIA CODE)

1. Applicant’s Name

Applicant’s Address

Philadelphia Address (If different from Applicant’s Address)

4. Contact Person (PLEASE PRINT)

5. Telephone Number

6. Federal Employee Identification

7. Applicant’s Philadelphia Tax Account Number

Number/Social Security Number

8. Date Business Began in Philadelphia

9. Desired Start Date for New Jobs in Philadelphia

10. Type of Business

11. Number of New Jobs to be Created in Philadelphia

Retail

12. Number of new jobs for Ex-Offenders to be Created in

Manufacture

Philadelphia

_____

Wholesale

Service

Other

13. Gross Receipts for the Four Years Prior to the

14. Net Income for the Four Years Prior to the

Start Date

YEAR

RECEIPTS

YEAR

NET INCOME

15. Type of Entity

Sole Proprietorship

Partnership

S Corporation

C Corporation

Other

Application For Job Creation Tax Credit - Pennsylvania Department Of Revenue