City Of Philadelphia Department Of Revenue Form - Renewal Application - Application Approval - Certification Of Non-Indebtedness To The City Of Philadelphia Page 4

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City of Philadelphia
Department of Revenue
Section II
Item 1: Indicate exact name of Community Development Corporation.
Item 2: Address of Community Development Corporation.
Item 3: Person to be contacted if additional information is needed.
Item 4: Telephone number of contact person.
Item 5: Geographic location of project.
Item 6: Indicate Federal Identification Number (EIN) assigned to the
Community Development Corporation.
Item 7: Indicate City Council District(s) of the Community Development
Corporation.
Section IV
This section certifies that the information provided in the application is true and correct
to the best of the signer’s knowledge. The signer must have the authority to bind the
applicant to the terms and conditions of Section 19-2604 (6) of the Philadelphia Code
and Section 501 of the Business Privilege Tax Regulations. False information may
subject the signer and company to criminal prosecution.
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