Form Rev-1193 - Neighborhood Improvement Zone Program Construction Contractor Tax Report Page 6
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6REV-1193 (12-12)
TAX REMITTANCE SUMMARY
Add all Line B totals from each tax schedule to arrive at the sum of state tax payments remitted to Pennsylvania
by the contractor performing construction services within the NIZ, and enter the figure below:
$
Add all Line D totals from each tax schedule to arrive at the sum of state taxes refunded to the contractor
within the NIZ, and enter the figure below:
$
TAXPAYER AFFIRMATION
“I hereby affirm under penalties prescribed by law that this report, including any accompanying schedules, has
been examined by me, and to the best of my knowledge and belief is a true, correct and complete report.”
Please sign after printing.
Signature of authorized taxpayer:
Print/Type preparer’s name:
Please sign after printing.
Preparer’s signature if different than the taxpayer:
MM/DD/YYYY
Date of Submission:
Do you want to allow another person to discuss this report with the department?
Yes
No
Designee’s name:
Phone number:
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