EITC Application

Application for Educational Improvement Tax Credits (Scholarship Org)

 

Business Name:

FEIN:

Street:

City:

County:

State:

Zip:

Business Description:

NAICS Code:

– search for codes at www.NAICS.com

CEO Name:

CEO Title:

Contact Name:

Contact Title:

Contact Phone #:

Contact FAX #:

Contact EMail:

Business Tax Year End (mm/dd):

PA Corporate Tax Account ID#:

Amount to be donated per year to a scholarship organization:

Based on the contribution stated above, this application is for the following commitment:

Calculated amount of tax credits requested per year:  


 

Please check the taxes to which the business is subject (check all that apply).
    

Corporate Net Income Tax
    

Capital Stock Franchise Tax    
    

Bank & Trust Company Shares Tax
    

Title Insurance Company Shares Tax    
    

Insurance Premiums Tax
    

Mutual Thrift Institutions Tax    
    

Personal Income Tax of S Corporation Shareholders, or partners in a general or limited partnership.



I hereby certify that all information contained herein is true and correct to the best of my knowledge.

I acknowledge that tax credits will be awarded only for approved contributions make to Scholarship Organizations listed by the Department (DCED) at www.newPA.com/EITC. I am aware that contributions must be made within 60 days of the date on the approval letter and receipts must be forwarded to DCED by the business within 90 days of approval. Furthermore, I acknowledge that if I knowingly make false statement to obtain tax credits, I (company, entity, and signer) may be subject to criminal prosecution.

Name of Signer:

Date:

Title:

By clicking the Submit button I certify that the name above constitutes my official signature for the electronic submission of this application.