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Georgia Form IT-QEE-SSO2
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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
Version 1
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 pursuant to Chapter 2A of Title 20.
1. Total number of individual contributions........................................
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00
2. Total dollar amount of individual contributions.............................
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,
00
3. Total dollar amount of individual preapproved tax credits............
4. Total number of corporate and fiduciary contributions.................
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00
5. Total dollar amount of corporate and fiduciary contributions......
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00
6.
Total dollar amount of corporate and fiduciary preapproved tax credits..
7.
Total number of scholarships awarded to eligible students.........
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00
8. Total dollar amount of scholarships awarded to eligible students
Such information as is required in (a) and (b) on page 2 is attached hereto:
CERTIFICATION BY STUDENT SCHOLARSHIP ORGANIZATION
The Student Scholarship Organization certifies that all information contained above and attached hereto
is true to their best knowledge and belief.
By: ____________________________________________________
Date:
Signature and Title of Authorized Officer
Name of Officer Signing
Phone Number