Form Cra - Combined Registration Application For State Of Delaware Business License And/or Withholding Agent - Division Of Revenue Page 22

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STATE OF DELAWARE
STATEMENT OF CONTRACTS
AWARDED BY GENERAL CONTRACTORS
Department of Finance
Division of Revenue
AND SUBCONTRACTORS
P.O. Box 8750
FORM 5060
Wilmington, Delaware 19899-8750
REV CODE
0028-16
THIS FORM MUST BE COMPLETED BY ALL CONTRACTORS WHO USE NON-RESIDENT SUBCONTRACTORS
1.
Enter Federal Employee Identification Number
OR
Social Security Number
1-
-
2-
-
-
2.
Name
(Submitted by:
General Contractor
Architect
Engineer
{Circle One})
3.
Business Name if Different from Above
4.
Business Location Address
5.
Location of Project
City
State
Zip Code
City
State
Zip Code
6.
Contract have been awarded to the following nonresident contractors and nonresident subcontractors:
Name & Address
Date of Award:
1
Employer ID No.
DE Business License No.
Amount of Contract
Business Code
Date of Award:
2
Employer ID No.
DE Business License No.
Business Code
Amount of Contract
Date of Award:
3
Employer ID No.
DE Business License No.
Amount of Contract
Business Code
Date of Award:
4
Employer ID No.
DE Business License No.
Business Code
Amount of Contract
Date of Award:
5
Employer ID No.
DE Business License No.
Amount of Contract
Business Code
(See back of return for additional space.)
Signature
Title
Telephone No.
Date

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