Commissioner of the Revenue
CITY OF NEWPORT NEWS
PLEASE MAKE ADDITIONAL COPIES AS NEEDED COR6-005
Company documents submitted in lieu of this form must contain the information requested on this form. 09/2014
SUBCONTRACTOR REQUEST FORM
BUSINESS NAME: _________________________________________ ACCOUNT NUMBER: _______________
As provided by the Code of the City of Newport News §23-22, the Office of the Commissioner of the Revenue requires
a detailed listing of all subcontractors and persons issued Federal Form 1099 used by your company for jobs performed
in the City of Newport News during the previous calendar year. Complete the information requested below and return
this form, as well as any necessary attachments, along with your Application for Business License renewal.
_________ NO, I did not subcontract work to others and did not issue any Federal Form 1099 for work done in
Newport News in the previous calendar year. If you have already indicated this on the center of the current
year’s Application for Business License, you will not be required to return this form.
_________ YES, I did subcontract Newport News work to others and / or did issue the Federal Form 1099 to the
following in the previous calendar year:
List Newport News Contracts Only
NAME ____________________________________________ Trading As __________________________________________
Federal Identification or Social Security Number________________________________________________________________
Address ________________________________________________________________________________________________
Telephone (__________) _____________________________ Type of Contractor ___________________________________
Newport News Job Location(s)______________________________________________________________________________
Amount paid to the subcontractor in (Enter last calendar year) Year: __________________ Amount Paid $ _____________
NAME ____________________________________________ Trading As __________________________________________
Federal Identification or Social Security Number________________________________________________________________
Address ________________________________________________________________________________________________
Telephone (__________) _____________________________ Type of Contractor ___________________________________
Newport News Job Location(s)______________________________________________________________________________
Amount paid to the subcontractor in (Enter last calendar year) Year: __________________ Amount Paid $ _____________
NAME ____________________________________________ Trading As __________________________________________
Federal Identification or Social Security Number________________________________________________________________
Address ________________________________________________________________________________________________
Telephone (__________) _____________________________ Type of Contractor ___________________________________
Newport News Job Location(s)______________________________________________________________________________
Amount paid to the subcontractor in (Enter last calendar year) Year: __________________ Amount Paid $ _____________
