An exemption from sales tax is allowed on all sales of tangible personal property or services purchased for the
construction, enlarging or remodeling of a business that has been certified through the High Performance Incentive
Program (HPIP). The sale and installation of machinery and equipment purchased for the installation at the business
shall also be exempt from sales tax.
Line (A) Enter the name of the entity that will operate the business facility and claim the sales tax exemption,
the employee identification number (EIN) and check the appropriate box identifying the business type.
Line (B)(1) Enter the name and EIN of the business, if it is different than line (A), above, and check the appropriate
box identifying the business type. If the taxpayer on line (A) operates under a Doing Business As
(DBA) name, enter the DBA.
Line (B)(2) Enter the location, including the county of the business facility where the investment is going to be
Line (B)(3) Enter the complete mailing address of the taxpayer who will own and/or operate the above referenced
Line (B)(4) Enter the email address of the authorized representative for the taxpayer.
Line (C) Check the applicable box(es) that describe the project and attach required documentation.
Line (D) Attach an explanation or list of improvements to be constructed, repairs or remodeling to be done, and
machinery and equipment to be purchased.
Line (E) Describe specifically the type of business activity to be conducted by the taxpayer at the business
Line (F) Indicate the type of business activity to be conducted at the business facility by the named taxpayer.
Line (F)(1) Certified business means a firm which is qualified by the Secretary of Commerce as meeting the
eligibility criteria for the High Performance Incentive Program (HPIP) pursuant to K.S.A. 2003 Supp. 74-
50,131. The firm must be entitled to the corporate tax credit established in K.S.A. 74-50,132 or must
have received written approval for participation and has participated, during the tax year in which the
exemption is claimed, in training assistance by the Department of Commerce under the Kansas
industrial training (KIT), Kansas industrial retraining (KIR) or state of Kansas investments in lifelong
learning program (SKILL). ATTACH a copy of the PD (project description) submitted to the
Department of Commerce pre-identifying this investment as well as the initial correspondence from the
Department of Commerce assigning the project number.
Line (G) Check the applicable box and list the name of the organization and/or person you were contacted by
and the average wage of the new (non-managerial) employees.
Line (H) List the name and address of the general contractor if available. If a general contractor does not exist
for this project, please attach a list of all the contractors/subcontractors (if available) involved in
performing labor services or supplying materials for the project. Include in this list, the estimated
project costs, contract date, contract number, and the estimated completion date for each contract.
Line (I) Enter the estimated cost of the project.
Line (J) Enter the date of the contract.
Line (K) Enter the applicable contract number if available.
Line (L) Enter the estimated completion date for this project. The Department requests that this period not
extend beyond two years from the application date.
Signature The name of the taxpayer as well as the authorized representative requesting the exemption should be
typed or printed in the area provided. The authorized representative must also sign the request and
provide a phone number where they can be reached during business hours.