Form Rev-1193 - Neighborhood Improvement Zone Program Construction Contractor Tax Report Page 3
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6REV-1193 (12-12)
NEIGHBORHOOD IMPROVEMENT ZONE PROGRAM
CONSTRUCTION CONTRACTOR TAX REPORT
Please type or print in black ink.
START
YYYY
1. Business Information
Calendar Year:
Legal Name:
Doing Business As (DBA)/Trade Name:
Job Site(s) within NIZ:
City:
State:
ZIP Code:
Please identify additional locations on a separate sheet.
2. Business Tax Account Information
Federal Employer Identification Number:
PA Sales/Use Tax License Number:
PA Employer Withholding Account Number:
PA Contractor’s Registration Number:
3. Contact Information
All questions concerning this report should be directed to the following contacts:
Name:
Title:
Telephone:
Email Address:
CONSTRUCTION SCHEDULE
This schedule is for construction contractors performing construction services as a construction contractor,
directly related to the improvement, development or construction of the neighborhood improvement zone.
Tax Payments
B) Sales and Use Tax Payments for Construction
$
Total sales and use tax paid for construction costs and materials related to the
improvement, development or construction of the NIZ remitted in the form of a payment on an invoice to a
vendor or supplier.
Tax Refunds
C) Sales and Use Tax Refunds for Construction
$
Total refunds granted for sales and use tax paid by a construction contractor
related to the improvement, development or construction of the NIZ.
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