Office of Policy & Research	Phone:	(785) 296-3498
Kansas Department of Revenue	Fax:	(785) 296-7928
915 SW Harrison Street
Topeka, KS 66612-1588

STATE OF KANSAS

PROJECT COMPLETION CERTIFICATE

TO:	City of Overland Park
Name of Entity to whom Project Exemption Certificate was Issued
8500 Santa Fe Drive	Overland Park	Kansas	66212
Street	City	State	Zip Code
This is to certify, to the best of my knowledge and belief, that all materials purchased under Exemption Certificate Number__________________________, issued by the Kansas Department of Revenue, were incorporated into the building or project for which the exemption was issued and were entitled to an exemption pursuant to K.S.A. 79-3606(d), (e), or (ee), as amended.
Contractor/Subcontractor
P.O. Box and/or Street Number and Name
City, State Zip
Signature and Title of Authorized Representative	Date
INSTRUCTIONS
Upon completion of a tax exempt project, the contractor must furnish this certification to the taxpayer for which the work was performed. A copy of this certificate must also be forwarded to the Kansas Department of Revenue, Office of Policy & Research, 915 SW Harrison Street, Topeka, Kansas 66612-1588. All invoices must be retained by the contractor for a period of five (5) years and are subject to audit by the Kansas Department of Revenue.

PR-77 (Rev. 7/98)

Project Completion Certificate

Nancy Sappington

2002-05-28

Joe Archer

City of Overland Park