Required fields are marked with a
Please let us know whether you have previously submitted KOZ application, or this
is the first time:
Please fill out required fields and Update other applicable Info.If you do not have these numbers,please bypass to complete the application.
Failure to check all that apply will limit your benefits.
Note: "LOT" is not
a Parcel ID#.
Date the company actively began Conducting business or anticipates moving into the
Date resident physically moved into the zone:
Date you purchased property:
Indicate how your entity type reports to the Internal Revenue Service.
Business Description (include products and / or services provided):
This section must be completed. If not applicable, enter zero.
Number of Full Time jobs at KOZ site when you first moved to KOZ:
Number of Full Time jobs at KOZ site now:
Amount of private capital investment (including cost or value of land) in the KOZ
site for the
Previous Year ():
Average Hourly Wage :
MUST be provided for applications from a business entity.
Sales Tax ID:(issued by Revenue)
Employer Acct. (employer withholding acct for employees of PA Personal Income TAX):
Corporate Box/Revenue ID (issued by Revenue):
Utility PURTA (for Utilities only):
Please enter SS# (if you are property owner, resident, or a sole proprietor):
Spouse's SS# (if applicable):
Provide the information requested in the boxes below for the following entities:
all share holders, partners, members, etc, of an S Corp, Partnership, LLC and all
persons or business that will receive pass through income from the business. (If
you need additional space PLEASE attach a Microsoft Excel spreadsheet)
Here you can upload an Excel file:
Where correspondence concerning all KOZ issues should be mailed
Please note that any non-compliant tax issue can only be communicated with the contact listed. It is the responsibility of the contact listed to forward the information to the appropriate tax contact if the contact provided is different.
Required fields needs to be filled in. which are marked with a