Tax Incentives Application - Puerto Rico Department Of Economic Development And Commerce

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Form Last Revised 04/10/2012
Commonwealth of Puerto Rico
Department of Economic Development and Commerce
Office of Industrial Tax Exemption
355 Franklin D. Roosevelt
Hato Rey, PR 00918
Tax Incentives Application
Economic Incentives for the Development of Puerto Rico Act (Act No.
73 of May 28, 2008)
Green Energy Incentives of Puerto Rico
(Act No. 83 of July 19, 2010)
Case No.
________________________________
□ New
□ Renegotiation
□ Other (Please Specify) __________________
Tax Incentive Grant:
Section I. Applicant’s General Information
Applicant’s Information
1
A.
Legal Name of Entity__________________________________________________________________________
Physical Address ____________________________________________________________________________
Mailing Address _____________________________________________________________________________
Telephone No. ___________________________
Fax No. __________________________________________
Electronic Mail ______________________________________________________________________________
Employer’s Identification Number_______________________________________________________________
□ Corporation
□ LLC
□ Partnership
□ Other _________________________
Type of Organization
□ Domestic (PR)
□ Domestic (US)
□ Foreign (non-US)
Residency
Registration Number ______________________
Date of Registration ________________________________
Organized under the laws of ____________________________________________________________________
2
NAICS
Classification(s) ______________________________________________________________________
B. Applicant’s Representative
Name ____________________________________________________________________________________
Title _____________________________________________________________________________________
Physical Address ___________________________________________________________________________
Mailing Address ____________________________________________________________________________
Telephone No. ______________________________
Fax No. ______________________________________
Email Address _____________________________________________________________________________
C. Name of Parent Company, if applicable. Please include organizational chart containing intermediate or
related entities)
Physical Address ___________________________________________________________________________
Mailing Address ____________________________________________________________________________
Telephone No. ______________________________
Fax No. _______________________________________
Web Page _________________________________
Email Address ________________________________
D. Principal Stockholder’s Information
Name
Social Security or
Address
Participation (%)
Employer ID Number
If the Applicant is part of a corporate group, please include organizational chart containing related entities.
E. Has the Applicant and/or any of its direct or indirect shareholders been subject to any investigation by, or
□ Yes □ No
subject to any payment plans with, the Department of Treasury?
1
Provide for each legal entity requesting incentives under the Act.
2
North American Industry Classification System. Find your code here:

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