Form Pub. Ks-1560 - Kansas Business Taxes For Schools & Educational Institutions (Page 32 of 37) in pdf

Form Pub. Ks-1560 - Kansas Business Taxes For Schools & Educational Institutions Page 32

Kansas Department of Revenue

Office of Policy and Research

915 SW Harrison St., Room 230

Telephone: (785) 296-3081

Topeka, KS 66612-1588

FAX: (785) 296-7928

STATE OF KANSAS

PROJECT COMPLETION CERTIFICATION

TO: ____________________________________________________________________________________________

Name of Entity to whom Project Exemption Certificate was Issued

_______________________________________________________________________________________________

Street Address

City

State

Zip Code

This is to certify, to the best of my knowledge and belief, that all materials purchased under Exemption Certificate Number

_______________________________________ , issued by the Kansas Department of Revenue, were incorporated into

the building or project for which the exemption was issued and were entitled to an exemption pursuant to K.S.A. 79-3606(d),

(e) or (cc), as amended.

_______________________________________________________________________________________________

Contractor / Subcontractor

_______________________________________________________________________________________________

P.O. Box and/or Street Number and Name

_______________________________________________________________________________________________

Street Address

City

State

Zip Code

_________________________________________________________

_________________________________

Signature and Title of Authorized Representative

Date

INSTRUCTIONS

Upon completion of a tax exempt project, the contractor must furnish this certification to the taxpayer for which the work was

performed. A copy of this certification must also be forwarded to the Kansas Department of Revenue, Office of Policy and

Research, 915 SW Harrison Street, Room 230, Topeka, Kansas 66612-1588. All invoices must be retained by the contractor

for a period of five (5) years and are subject to audit by the Kansas Department of Revenue.

PR-77 (Rev. 6/08)

Form Pub. Ks-1560 - Kansas Business Taxes For Schools & Educational Institutions Page 32