Notice Of Intent For Georgia Jobs Tax Credit Form

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Notice of Intent
For
Georgia Jobs Tax Credit
___________________________________________________
1.
Name of Company:
_________________________________________________
2.
Address of Company:
3.
Address of Business Establishment Creating Jobs: _______________________________
________________________________________________________________________
4.
Name of County in which Jobs will be Created: _________________________________
5.
Number of New, Full-time Jobs to be Created: __________________________________
6.
Year(s) in which Jobs will be Created: ________________________________________
________________________________________________________________________
7.
Type of Business Establishment (list SIC code): _________________________________
________________________________________________________________________
Whereas the aforementioned company has abided by and will abide by all Job Tax Credit
Program rules and regulations, application is hereby made to the Georgia Department of
Community Affairs for certification that the herein proposed new, full-time job creation will
qualify as new, full-time jobs in a tier ___________________ County (or in the
____________________
Less
Developed
Census
Tract
Area)
whether
or
not
__________________County (the ________________Less Developed Census Tract Area)
retains its current tier/less developed census tract designation.
____________________________
____________________________
Date
Signature of Officer
____________________________
Print Officer’s Name
____________________________
Title
____________________________
Phone Number
Department Use Only
Mailing Address:
Accepted:
Job Tax Credit Program Coordinator
Georgia Department of Community Affairs
60 Executive Park South, NE
Atlanta, Georgia 30329
____________________________
Date
____________________________
By
12/8/98

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