Form Naa-02 - 2008 Connecticut Neighborhood Assistance Act Business Application
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1Department of Revenue Services
Reset Form
State of Connecticut
(Rev. 02/08)
Form NAA-02
2008 Connecticut Neighborhood Assistance Act
Business Application
Each business firm requesting a tax credit under the Neighborhood Assistance Act Program must
complete and submit this form for each cash contribution for which a tax credit is being requested.
Form NAA-02 must be mailed or hand-delivered to the Department of Revenue Services,
25 Sigourney Street, Hartford CT 06106, Attn: Research Unit, on or after September 15, 2008,
but no later than October 1, 2008. A faxed Form NAA-02 will not be accepted.
Subchapter S Corporations, Limited Liability Companies, Limited Liability Partnerships, and Limited
Partnerships are not eligible for the credit. For additional information, contact the Research Unit at
860-297-5687.
Part I: Business Firm Information
Business Firm Name: _______________________________________________________
Address: _________________________________________________________________
Federal Employer Identification Number: _________________________________________
Connecticut Tax Registration Number: ___________________________________________
Income Year Ending: ________________________________________________________
Name of Contact Person: _____________________________________________________
Title: _____________________________________________________________________
Email Address of Contact Person: ______________________________________________
(
)
Telephone Number: _________________________________________________________
Part II: Program Proposal Information
Organization/Municipal Agency: ________________________________________________
Program Title: _____________________________________________________________
Municipality Approving Program: _______________________________________________
Amount of Cash Contribution: $ ________________________________________________
($250 Minimum)
Has this contribution been made?
Yes
No
______________
______________
If Yes, date made:
If No, date to be made:
Note: The business must make its contribution during its 2008 income year.
_________________________
______________________________
Signature of Authorized Representative
Name and Title of Authorized Representative
of Business Firm
of Business Firm
(Do Not Use Black Ink)
(Please Print)
________________________
Date
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