Fillable REQUEST FOR PROJECT EXEMPTION CERTIFICATE PURSUANT TO K.S.A. (Kansas Department of Commerce)

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REQUEST FOR PROJECT EXEMPTION CERTIFICATE PURSUANT TO K.S.A. (Kansas Department of Commerce)

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PR-70b (Rev. 1/14)
REQUEST FOR PROJECT EXEMPTION CERTIFICATE
PURSUANT TO K.S.A. 79-3606 (cc)
Kansas Department of Revenue
Office of Policy and Research
915 SW Harrison St.
Topeka, KS 66612-1588
Telephone: (785) 296-3081
FAX: (785) 296-7928
Date
(A)
It is requested that a Certificate of Exemption from sales tax be issued to the taxpayer for the following described project.
Name of taxpayer: EIN:
Business type:
Corporation L.L.C. Limited Liability Partnership/Partnership Individual
Other
(B) 1. Name of business which will operate the business facility (if different from the name listed on Line (A)):
EIN:
Business type: Corporation
L.L.C. Limited Liability Partnership/Partnership Individual
Other
2. Location of business facility investment:
Street Number and Address
County: City: State: Zip:
3. Mailing address of taxpayer (business) who will own and/or operate the business facility:
Box Number and/or Street Number and Name
City: State: Zip:
4. Email Address:
(C)
Type of project:
Original construction of a new facility
Addition to an existing facility
Remodel or reconstruction of an existing facility
Additional machinery and equipment, not to include
the purchase of a motor vehicle or trailer.
(D) ATTACH an explanation or list of improvements to be constructed, repairs or remodeling to be done, and machinery and
equipment to be purchased.
(E) Describe specifically the type of business activity to be conducted by the taxpayer [name on Line (A)] at the business facility:
(F) Indicate the type of business conducted by the named taxpayer. See instructions.
1. CERTIFIED BUSINESS
The business has been certified by the Department of Commerce as meeting the eligibility criteria for the High
Performance Incentive Program (HPIP). Attach a copy of the letter of certification.
(G) Is this project a result of working with officials of the state, county, or city government? Yes No
If yes, provide the name of the agency and contact:
What will be the average annual wage for new (non-managerial) employees?
(H) List the name(s) and address(es) of the general contractor(s):
(I) Estimated project costs: Total Construction costs:
Machinery and equipment costs:
(J)
Contract date: (K) Contract No.:
(L) Estimated completion date (not to exceed two years):
Taxpayer (please type or print)
Name of Authorized Representative (please type or print)
Signature of Authorized Representative
Title Phone Number
INSTRUCTIONS
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
made.
Line (B)(3) Enter the complete mailing address of the taxpayer who will own and/or operate the above referenced
business facility.
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
facility.
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.
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REQUEST FOR PROJECT EXEMPTION CERTIFICATE PURSUANT TO K.S.A. (Kansas Department of Commerce)

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Completed 20 July 2020

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