Form Naa-02 - Connecticut Neighborhood Assistance Act Business Application - 2013
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Department of Revenue Services
2013
State of Connecticut
Form NAA-02
(Rev. 02/13)
2013 Connecticut Neighborhood Assistance Act Business Application
Each business firm requesting a tax credit under the
Legislation enacted in 2011 expanded the eligibility
Neighborhood Assistance Act (NAA) Program must
for the NAA program to include any business entity
complete and submit Form NAA-02 for each cash
authorized to do business in Connecticut and subject
contribution for which a tax credit is being requested.
to the Business Entity Tax. However, for purposes of a
Form NAA-02 must be mailed or hand-delivered (no
business entity subject to the Business Entity Tax, the
faxes will be accepted) on or after September 15,
credit may only be used by the members or partners of
the entity that are subject to the Corporation Business
2013, but no later than October 1, 2013, to:
Tax.
Department of Revenue Services
The business must make its contribution during
Research Unit
its income year that begins in 2013.
25 Sigourney St Ste 2
For additional information, contact the Department
Hartford CT 06106-5032
of Revenue Services (DRS), Research Unit at
860-297-5687.
Part I - Business Firm Information
Business name
CT Tax Registration Number
Business address
Number and street
PO Box
City or town
State
ZIP code
Name of contact person
Telephone number
Title
Email address of contact person
May DRS approve this application through an email to your contact person?
Yes
No
Enter income year beginning
, 2013, and ending
,
______________________________
___________________________
___________
Type of business
Other (specify)
C Corporation
______________________________ ________________________________________
Tax type against which the credit will be used
Corporation Business Tax
Insurance Premiums Tax
Public Service Companies Tax
Part II - Program Proposal Information
Organization/municipal agency
Program title
Municipality approving program
Amount of cash contribution ($250 minimum).
$
________________________________________________________
________________________________________________________________
Authorized representative’s name (print)
Authorized representative’s title
________________________________________________________
________________________________________________________________
Authorized representative’s signature (Do not use black ink)
Date
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