Form Pr-70b - Request For Project Exemption Certificate - Kansas Department Of Revenue
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1REQUEST FOR PROJECT EXEMPTION CERTIFICATE
PURSUANT TO K.S.A. 79-3606(cc)
Kansas Department of Revenue
Office of Policy and Research
915 SW Harrison St.
Telephone: (785) 296-3081
Topeka, KS 66612-1588
FAX: (785) 296-7928
Date ______________________________
It is requested that a Certificate of Exemption from sales tax be issued to the taxpayer for the following described project.
(A)
Name of taxpayer: _________________________________________________
EIN: _______________________________
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Business Type:
Corporation
L.L.C
Limited Liability Partnership/Partnership
Individual
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Other ____________________________________________________________________________
(B)
1.
Name of business which will operate the business facility – if different from the name listed on Line (A):
________________________________________________________________
EIN: _______________________________
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Business Type:
Corporation
L.L.C
Limited Liability Partnership/Partnership
Individual
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Other ____________________________________________________________________________
2.
Location of business facility investment: __________________________________________________________________
Street Number and Address
County: ______________________
City: _______________________________
State: _________ Zip: _______________
3.
Mailing address of taxpayer (business) who will own and/or operate the business facility:
_____________________________________________________________________________________________________
Box Number and/or Street Number and Name
City: ___________________________________________
State: _____________________ Zip: ______________________
4.
Email address: _____________________________________________________________________________________
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(C)
Type of project:
Original construction of a new facility
Remodel or reconstruction of an existing facility
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Addition to an existing facility
Additional machinery and equipment, not to include
the purchase of a motor vehicle or trailer.
(D)
ATTACH an explanation or list of improvements to be constructed, repairs or remodeling to be done, and machinery and
equipment to be purchased.
(E)
Describe specifically the type of business activity to be conducted by the taxpayer [name on line (A)] at the business facility:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
(F)
Indicate the type of business conducted by the named taxpayer. See instructions.
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1. CERTIFIED BUSINESS
The business has been certified by the Department of Commerce as meeting the eligibility criteria for the High Performance
Incentive Program (HPIP). Attach a copy of the letter of certification.
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(G)
Is this project a result of working with officials of the state, county, or city government?
Yes
No
If yes, provide the name of the agency and contact: _____________________________________________________________
What will be the average annual wage for new (nonmanagerial) employees? $ _____________________________________
(H)
List the name(s) and address(es) of the general contractor(s): ___________________________________________________
( I )
Estimated project costs: Total $ ___________________________
Constructions costs: $ __________________________
Machinery and equipment costs $ _________________________________________________________________________
(J)
Contract date: _________________________________
(K) Contract Number ____________________________________
(L)
Estimated completion date (not to exceed two years): ___________________________________________________________
__________________________________________________
____________________________________________________
Taxpayer (please type or print)
Name of Authorized Representative (please type or print)
PR-70b
(Rev. 1/14)
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