Job Creation Tax Credit - Application - City Of Philadelphia

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Job Creation Tax Credit – APPLICATION (PART 1 of 3)
1.
NAME
___________________________________________________
2.
ADDRESS
___________________________________________________
3.
CITY
___________________________________________________
4.
STATE
___________________________________________________
5.
ZIP CODE
___________________________________________________
6.
PHILADELPHIA ADDRESS (if different) _____________________________
7.
ZIP CODE
___________________________________________________
8.
CONTACT PERSON
________________________________________
9.
TELEPHONE
_____________________________________________
10.
EMAIL
___________________________________________________
11.
FEDERAL EMPLOYER ID NO. / SOCIAL SECURITY NO. _______________
12.
PHILADELPHIA TAX ACCOUNT NO.
_____________________________
13.
# OF JOBS IN PHILADELPHIA AS OF YOUR SELECTED START DATE ___
14.
# OF JOBS WORLDWIDE AS OF YOUR SELECTED START DATE _______
15.
TYPE(S) OF BUSINESS(ES)
Retail
RETAIL
Wholesale
WHOLESALE
Service
SERVICE
Manufacturing
MANUFACTURING
Other
OTHER
16.
NAIC CODE
_____________________________________________
17.
NAIC DESCRIPTION
________________________________________
18.
TYPE OF ENTITY
Sole Proprietorship
SOLE PROPRIETORSHIP
S Corporation
S CORPORATION
C Corporation
C CORPORATION
Partnership
PARTNERSHIP
Other
OTHER
IF DISREGARDED ENTITY, OWNER: _________________________
Rev 06/17
3

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