Form It-Qiepc - Qualified Interactive Entertainment Production Company Certification Form
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IT-QIEPC (Rev. 6/14)
QUALIFIED INTERACTIVE ENTERTAINMENT PRODUCTION
COMPANY CERTIFICATION FORM
For taxable years beginning on or after January 1, 2014, this form must be submitted by a
Qualified Interactive Entertainment Production Company* to the Department of Revenue
to request certification under O.C.G.A. § 48-7-40.26(e)(8) for the Film Tax Credit.**
Name of the Qualified Interactive Entertainment Production Company
FEI Number
Georgia Business Location Street Address
Type of Business:
Partnership/LLC
C Corporation
S Corporation
Georgia Business Location City, State and Zip Code
Date of Submission:
Contact Person
Telephone Number of Contact Person
Street Address of Headquarters of Qualified Interactive Entertainment
City, State and Zip Code of Headquarters of Qualified Interactive
Production Company (if different)
Entertainment Production Company (if different)
Part 1.
Tax Year Beginning _____________________
Please respond to questions 1 and 2 below with either a Yes or No
response.
1. Does this Qualified Interactive Entertainment Production Company maintain a
business location physically located in Georgia? ________________
2. Has this Qualified Interactive Entertainment Production Company expended a total
aggregate payroll*** of $500,000.00 or more for employees working within Georgia
during the calendar year directly preceding the start of the taxable year of the
Qualified Interactive Entertainment Production Company?
___________________
3a. Total payroll during the calendar year directly preceding the start of the taxable
year of the Qualified Interactive Entertainment Production Company
$_______________
3b. Total aggregate payroll*** for employees working within Georgia during the
calendar year directly preceding the start of the taxable year of the Qualified
Interactive Entertainment Production Company $_______________
1.
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