Released at the start of each year, Form Pa01 424 is an important document for all Pennsylvania taxpayers. This form is used to calculate your state income tax liability for the previous calendar year. If you need help completing Form Pa01 424, be sure to consult a tax professional. Filing this form incorrectly can lead to penalties and interest charges from the state government. Thankfully, there are many online resources available to help you prepare this form correctly. Make sure you review all of your options before filing so that you can choose the best method for you. Thanks for reading!
| Question | Answer |
|---|---|
| Form Name | Form Pa01 424 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | welding supp (penn) penn america welding supplemental form |
Welders Supplemental Application
Applicant Name_____________________________________________________________________
Applicant Address___________________________________________________________________
City______________________________ |
State ____________ Zip Code_____________________ |
Number of years in business? _________ |
Payroll______________ Sales _____________________ |
Is any work subcontracted? ______________________ What is the cost? ______________________
Are certificates of insurance secured from subcontractors? ___________________________________
What limits of liability are carried by subcontractors? ________________________________________
Prior carrier and three- year loss history
CarrierYear Premium Describe Losses
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
List and describe the last three jobs performed by the insured including the receipts:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Please provide a description of the typical work performed by the insured including customers served
and end use of any products
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Does the insured perform work for any of the following industries?
_____ |
Aerospace |
_____ |
Industrial |
_____ |
Refineries |
|
|
|
|
|
|
_____ |
Aircraft |
_____ |
Ladders |
_____ |
Residential |
|
|
|
|
|
|
_____ |
Automotive |
_____ |
Medical |
_____ |
Scaffolding |
|
|
|
|
|
|
_____ |
Bridges |
_____ |
Marine |
_____ |
Structural Work |
|
|
|
|
|
|
_____ |
Chemical |
_____ |
Mining |
_____ |
Tanks |
|
|
|
|
|
|
_____ |
Commercial |
_____ |
Oil/Gas |
_____ |
Townhomes |
|
|
|
|
|
|
_____ |
Condos |
_____ |
Pipelines |
_____ |
Tract Homes |
|
|
|
|
|
|
_____ |
Cranes, Conveyors |
_____ |
Pressurized Vessels |
_____ |
Trailer Hitches |
or Hydraulics |
If the answer is yes to any of the above, describe work performed. If there is structural welding, advise the number of stories and type of structural work being performed.
____________________________________________________________________________________
____________________________________________________________________________________
The undersigned is an authorized representative of the applicant and certifies that reasonable inquiry has been made to obtain the answers to questions on this application. He/she certifies that the answers are true, correct and complete to the best of his/her knowledge.
__________________________ __________ |
___________________________ |
_________ |
|
Applicant Signature |
Date |
Producer’s Signature |
Date |
|
Page 1 of 1 |
||