REQUEST FOR PROJECT EXEMPTION CERTIFICATE                                                      471420 
       PURSUANT TO K.S.A. 79-3606 (cc) OR K.S.A. 79-3606(hhhh) OR K.S.A. 79-3606(oooo)
Kansas Department of Revenue                                                                                Telephone: 785-296-3081
Office of Policy and Research                                                                                       FAX: 785-296-7928
PO Box 3506
Topeka, KS 66601-3506                                                                                  Date:
It is requested that a Certificate of Exemption from sales tax be issued to the taxpayer for the following described project.

(A) 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   Remodel or reconstruction of an existing facility
                                      Addition to 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 – K.S.A. 79-3606(cc)
           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.
      2.  AGRICULTURAL BUSINESS – K.S.A. 79-3606(hhhh)
           The business must have a project with actual costs of $50,000 or more and must be identified under the North American
           industry classification system (NAICS) subsectors 112112, 112120, 112210, 1123, or 1124, (See instrs).
      3.  QUALIFIED FIRM OR QUALIFIED SUPPLIER – K.S.A. 79-3606(oooo)
           The business has entered into an agreement with the Department of Commerce as meeting the requirements of the
           attracting powerful economic expansion program.  Attach a copy of the letter of approval.
(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: Tota :l                                           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

PR-70b Rev. 10-22

                                                    INSTRUCTIONS

Certified Business – K.S.A. 79-3606(cc): An exemption from sales tax is allowed on all sales of tangible personal property or
services purchased for the construction, reconstruction, 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 installation at
the business shall also be exempt from sales tax.
Agricultural Business – K.S.A. 79-3606(hhhh): An exemption from sales tax is allowed on and after July 1, 2014 for all sales of
tangible  personal property or services purchased for the construction, reconstruction, enlarging or remodeling of a business
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. The sale and installation of machinery and equipment purchased for installation at the business shall also be 
exempt from sales tax. Only those projects that have total actual costs of $50,000 or more will qualify.
Qualified Firm or Qualified Suppler – K.S.A. 79-3606(oooo): An exemption from sales tax is allowed on all sales of tangible
personal property or services purchased for construction, reconstruction, enlarging or remodeling a qualified business facility by
a qualified firm or qualified supplier which meets the requirements of the Attracting Powerful Economic Expansion Program and
has entered into an agreement with the Department of Commerce. The sale and installation of machinery and equipment
purchased for installation at the qualified business facility 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 – 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 (F)(3) Qualified Firm or Qualified Suppler – K.S.A. 79-3606(oooo): A qualified firm or qualified supplier must be
            approved and certified by the Department of Commerce.
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.