Form Naa-02 - 2005 Connecticut Neighborhood Assistance Act Business Application
ADVERTISEMENT
1Department of Revenue Services
State of Connecticut
(Rev. 2/05)
Form NAA-02
2005 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, 2005,
but no later than October 3, 2005. 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: _____________________________________________________________________
E-mail 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)
(NOTE: Credit is 60% of amount contributed for all approved programs)
Has this contribution been made?
Yes
No
______________
______________
If “Yes,” date made:
If “No,” date to be made:
(
)
NOTE: Contribution must be made during the income year of the business beginning during 2005.
_________________________
______________________________
Signature of Authorized Representative
Name and Title of Authorized Representative
of Business Firm
of Business Firm
(Do Not Use Black Ink)
(Please Print)
________________________
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial