Form Uz-5-Sb-A - Application For Exemption From Sales Tax

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STATE OF NEW JERSEY
UZ-5-SB-A
DIVISION OF TAXATION
10-10
Application for Exemption from Sales Tax on Purchases of Goods and Materials for Exclusive Use or
Consumption within an Urban Enterprise Zone
1. NJ Taxpayer ID #: ____ ____ ____ -____ _____ ____ -____ ____ ____ / ____ ____ ____
2. Name of Business (Individual, Partnership or Corporate Name) ______________________________________________________
Trade Name/Alternative Name (if any)_____________________________________________________________________________
Business Address in the Urban Enterprise Zone_____________________________________________________________________
City_______________________________________________
State _______________________
Zip Code _______________
E-mail Address ______________________________________________________________________________________________
3. Contact Name _____________________________________________________________________________________________
4. Contact Telephone Number _____________________________
5. Contact E-mail Address _____________________________
6. Principal Product or Service ______________________________________________________
7. Re-certification Beginning Date _____________________________ Re-certification Ending Date __________________________
8. UEZ File Number __________________________________
______________________________________________________________________________________
Please check the following box that pertains to your business. The Division will verify the business gross receipts based on
the tax data available.
___
|__| The business gross receipts from all locations of this business entity for the prior annual tax period were less than $10
million. I am requesting that you certify the business listed above as a qualified small business and that you issue to this
business a UZ-5-SB Exempt Purchase Certificate.
___
|__| The business gross receipts from all locations of this business entity for the prior annual tax period were $10 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 purchased by this business entity for use or consumption exclusively at its zone location.
______________________________________________________________________________________
The business listed on this application must be in full tax compliance with the State of New Jersey before any certification,
recertification of eligibility in the Urban Enterprise Zone (UEZ) program, or the awarding of a business incentive or grant
associated with the UEZ program is authorized.
I consent to the release of information by the Division of Taxation to the Urban Enterprise Zone Authority (within the New
Jersey Department of Community Affairs), municipal Urban Enterprise Zone coordinators, and the New Jersey Division of
Revenue, which shall be limited solely to the business’s tax compliance status and verification of annual gross receipts for
the duration of the application and renewal processes.
_______________________________________________________________________________
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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