Fillable Fillable Request For Tax Paid Certificate 2019 (City of Colorado Springs)

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Fillable Request For Tax Paid Certificate 2019 (City of Colorado Springs)

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CITY OF COLORADO SPRINGS
REQUEST FOR TAX PAID CERTIFICATE
(CITY PROJECTS ONLY)
City Project Contract Information
Contract Number:
Contract Name:
Contract Amount (including all change orders): $
General Contractor Information
Company Name:
Physical Address (include city, state, zip code):
Mailing Address (include city, state, zip code):
Phone:
Email:
List all contractors on the project (company name, contact name, phone & email).
If you already have a listing of contractor information that includes the items requested below, please note “see
attached” and attach to this request.
*Check that both the ST-17 COS INT Assignment of Right and Materials Summary are attached for each contractor*
Subcontractor Information
Company Name:
Contact Name:
ST17 Cert* ST17 Mat*
Phone:
Email:
Company Name:
Contact Name:
ST17 Cert* ST17 Mat*
Phone:
Email:
Company Name:
Contact Name:
ST17 Cert* ST17 Mat*
Phone:
Email:
Company Name:
Contact Name:
ST17 Cert* ST17 Mat*
Phone:
Email:
Company Name:
Contact Name:
ST17 Cert* ST17 Mat*
Phone:
Email:
Company Name:
Contact Name:
ST17 Cert* ST17 Mat*
Phone:
Email:
Company Name:
Contact Name:
ST17 Mat*
Phone:
ST17 Cert*
Email:
*List additional contractors on a separate sheet if needed*
Continued
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no
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City Project Manager Information
Name:
Date Submitted:
Department:
Phone:
Email:
Please submit the Request for Tax Paid Certificate to:
Construction, Sales Tax
Mail Code 225 or Email Construction_salestax@Coloradosprings.gov
This request form must be completed in full and an ST-17 package (both forms) must be attached for each
contractor listed, including the General Contractor. If the request is incomplete it will not be processed.
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Fillable Request For Tax Paid Certificate 2019 (City of Colorado Springs)

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Completed 21 January 2021

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