Form Pr 70B – Fill Out and Use This PDF

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-K.S.A. 79-3606(cc): 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 (F)(2)

Agricultural Business-K.S.A. 79-3606(hhhh): An agricultural business must be identified under the

North American industry classification system (NAICS) subsectors: 112112-Cattle Feedlots; 112120-

Dairy Cattle and Milk Production; 112210 Hog and Pig Farming; 1123-Poultry and Egg Production; or

1124-Sheep and Goat Farming. This qualifying NAICS must be on file with the Kansas Department of

Labor for your specific facility address that has been provided on this application. Only those projects

that have total actual costs of $50,000 or more will qualify.

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.