Print
Clear
Page 1
Georgia Form IT-QEE-SSO2
(
Last Rev. 8/13)
Please print your numbers like this in black or blue ink:
Please print your numbers like this in black or blue ink:
Qualified Education Expense Credit Reporting Form
Georgia Department of Revenue
This form is used only by the student scholarship organization. It is used to provide the information
required by the Official Code of Georgia Annotated.
Enter for the Student Scholarship Organization:
TAXPAYER IDENTIFICATION NUMBER
FISCAL YEAR ENDING
NAME OF STUDENT SCHOLARSHIP ORGANIZATION
DEPARTMENT USE ONLY
STREET ADDRESS
CITY
STATE
ZIP CODE
CONTACT PERSON
TELEPHONE NUMBER OF CONTACT PERSON
The Official Code of Georgia Annotated establishes an income tax credit for qualified education expenses. A credit is allowed for
the expenditure of funds by the taxpayer to a student scholarship organization, operating pursant to Chapter 2A of Title 20.
1. Total number of individual contributions eligible for the credit...........................................
,
,
.
00
2. Total dollar amount of individual contributions eligible for the credit................................
,
.
,
00
3.
Total dollar amount of individual preapproved tax credits...................................................
4.
Total number of corporate and fiduciary contributions eligible for the credit....................
,
,
.
00
5.
Total dollar amount of corporate and fiduciary contributions eligible for the credit.........
,
.
,
00
6.
Total dollar amount of corporate and fiduciary preapproved tax credits............................
7.
Total number of scholarships awarded to eligible students.................................................
,
,
.
00
8.
Total dollar amount of scholarships awarded to eligible students......................................
9. Number of families of scholarship recipients who fall within each quartile of Georgia adjusted gross income as defined and reported on
the Georgia Department of Revenue’s website.
1st Quartile
2nd Quartile
3rd Quartile
4th Quartile
10. Average number of dependents of families of scholarship recipients for each quartile of Georgia adjusted gross income as defined and
reported on the Georgia Department of Revenue’s website.
1st Quartile
2nd Quartile
3rd Quartile
4th Quartile
.
.
.
.