Form It-Hq - Application For Georgia Headquarters Job Tax Credit Page 3
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5IT-HQ
(REV 4/02)
C. PROJECT CATEGORY: (please check one)
[ ] Established New Headquarters
[ ] Relocating Headquarters
Location ___________________
Location (from where) ______________________
Location (to where) ________________________
D. SUMMARY OF Expenses at Headquarters (please note that total investment must exceed
$1 million prior to use of this incentive)
1. Land Cost............................................................................... $ __________________________________
2. Building cost (new construction) ........................................... $ __________________________________
3. Purchase or Lease of Existing Facility Structure ................... $ __________________________________
4. Renovations or Improvements to Existing Structure.............. $ __________________________________
5. Office Furniture and Fixtures................................................. $ __________________________________
6. Machinery and Equipment..................................................... $ __________________________________
7. Other (please identify separately) .......................................... $ __________________________________
Total Headquarters Cost (by county)
E. LIST ALL INCENTIVES/INDUCEMENTS (INCLUDING ANY TAX CREDITS CURRENTLY IN PLACE
OR THAT WILL BE APPLIED FOR THE PROJECT DURING THE PERIOD THAT THE TAXPAYER
CLAIMS THE HEADQUARTERS JOB TAX CREDIT).
F. At a minimum, attach a schedule which provides the information below for all Headquarters employees:
(Note: Wage means average weekly wage, and includes bonuses, incentive pay, etc.)
Employee Name
Social Security #
Wage
Percent above
Headquarters Duties
County Avg.
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Parent category: Financial