UZ-5-SB-A
STATE OF NEW JERSEY
2-08
DIVISION OF TAXATION
Application for Exemption from Sales Tax on Purchases of Goods and Materials for Exclusive Use or
Consumption within an Urban Enterprise Zone
1. NJ Taxpayer ID #: ____ ____ ____ - ____ ____ ____ - ____ ____ ____ / ____ ____ ____
2. Name of Business (Individual, Partnership or Corporate Name) _____________________________________________________________________
Trade Name (if any) _______________________________________________________________________________________________________
Business Address in the Urban Enterprise Zone _________________________________________________________________________________
City_____________________________________________________
State __________________________
Zip Code ________________
E-mail Address ___________________________________________________________________________________________________________
3. Contact Name ___________________________________________________________________________________________________________
4. Contact Telephone Number _______________________________________________________________
5. Contact E-mail Address __________________________________________________________________
6. Principal Product or Service ______________________________________________________________
7. UEZ File Number ______________________________________________________________________
8. Re-certification Beginning Date: ___________________________________ Re-certification Ending Date: ___________________________________
Please check the following box that pertains to your business. The Division will verify the business gross receipts based on the
tax data available.
The business gross receipts from all locations of this business entity for the prior annual tax period were less than
$3 million. I am requesting that you certify the business listed above as a qualified small business and that you issue to
this business a UZ-5-SB Exempt Purchase Certificate.
The business gross receipts from all locations of this business entity for the prior annual tax period were $3 million or
more. I will be applying to the Division of Taxation for refunds of any use tax and/or sales tax paid at the point of
purchase for goods and materials for use or consumption exclusively within the zone.
I certify that I am authorized to complete this application; that it is true and complete; and I HEREBY CONSENT TO THE RELEASE OF TAX
INFORMATION OF THE APPLICANT BY THE DIVISION OF TAXATION TO THE UEZ AUTHORITY AND COORDINATORS AND THE NEW
JERSEY DIVISION OF REVENUE.
____________________________________________________________________________________________________________________________
Signature of Owner, Partner or Officer
Print or Type Name and Title
Date
,
,
,
THIS FORM MUST BE COMPLETED
SIGNED
AND RETURNED TO YOUR MUNICIPAL UEZ LOCAL COORDINATOR
ALONG WITH YOUR
-
APPLICATION FOR UEZ CERTIFICATION OR RE
CERTIFICATION
SEE INSTRUCTIONS ON REVERSE SIDE