Form It-Hc - Certification Of Georgia Housing Tax Credit
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IT-HC (Rev. 12/13)
STATE OF GEORGIA
Departments of Revenue, Insurance and Community Affairs
Certification of Georgia Housing Tax Credit
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completed by DCA
Part lA. Credit
1. Building Address
2. Building Owner and Address
1
3. Building Owner TIN
4. Federal Building Identification Number
5. Maximum Allowable GHTC Amount
6. Date Building Placed in Service
Signature of Authorized DCA Official
Date
Part IB. Owner Certification
Ownership Entity
Under penalties of perjury, I declare that: (1) the above building continues to qualify as a part of a
qualified low-income housing development and meets the requirements of Internal Revenue Code
Section 42 (g) and O.C.G.A. Section 48-7-29.6 and (2) the qualified basis of the building (check one)
_____has _____has not decreased for this tax year. I have examined this form, and to the best of my
knowledge and belief, it is true, correct and complete.
Signature
Taxpayer ID Number
Date
Name (please type or print)
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TIN refers to Taxpayer identification number.
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Parent category: Financial