Form Rev 81 1023e - Corporate Headquarters Application For Sales And Use Tax Deferral - Washington Department Of Revenue - 2013 Page 3
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1
2
3Audit Records Location
Lessee/Lessor Information (if applicable)
Yes
No
9. Will the facility housing the operation be
If your application is approved, a deferral certificate will be
issued using the estimates from your application. Upon
leased by the applicant to a qualified lessee?
completion of the project, an auditor will verify qualified
10. Name of business or entity that is paying for the
activities at this facility. The auditor may adjust the allowable
construction of the building or improvements.
deferral based on the audit findings.
To minimize inconvenience and the time it takes to complete an
audit, please have the following records for the audit period
11. Name of the individual or entity that will be
available for your meeting with the auditor:
headquartered at this location:
Purchase invoices (i.e., accounts payable, receipts)
Supporting documentation for the construction,
12. Department of Revenue Tax Reporting Number of
such as construction contracts
business in #11.
Original Sales and Use Tax Deferral Certificate
Although most audits can be completed with the above records,
13. Do the lessee and lessor have 100% same
additional documents may be required during the audit.
ownership?
If yes, please provide official
documentation to substantiate the
relationship. (For example: Articles of
Incorporation)
If the answer is “no”, complete a
Print Name
Corporate Headquarter Application for
Sales and Use Tax Deferral for Lessor
and attach a copy of the lease agreement
reflecting the economic benefit of the
Title
Date
deferred tax is passed onto the lessee
by any type of payment, credit, or
other financial arrangement between
Applicant’s Signature
the lessor and qualified lessee.
(The lessee that receives the economic
benefit must agree in writing to
complete the annual tax incentive
Questions:
Call (360) 570 3265 option 6
survey. (Attach Copy))
Mail or Fax To:
Department of Revenue
Special Programs Division
PO Box 47477
Use of Facility
Olympia, WA 98504-7477
FAX: (360) 586-2163
All businesses must maintain a qualified activity at the site of the
investment project for the year in which the investment project is
certified as operationally complete (by Revenue), plus seven
Print This Form (all copies)
additional years.
Yes
No
14. Do you plan to operate this investment
project in a qualified manner for 8
years from the time the project is
certified as complete?
If the answers “no”, how long do
you plan to operate this
investment project with qualified
use?
If the qualifying activity is not maintained, all or a portion of the
deferred taxes outstanding for this investment will be
immediately due. The department will assess interest at the rate
provided for delinquent excise taxes, but not penalties, retroactive
to the date of the deferral.
For tax assistance or to request this document in an alternate format, please call 1-800-647-7706. Teletype (TTY) users may use the
Washington State Relay Service by calling 711.
REV 81 1023e (5/14/13)
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