Form It-Qj - Application For Georgia Quality Jobs Tax Credit Page 3

IT-QJ

(REV 2/10)

C. PROJECT CATEGORY: (PLEASE CHECK ONE)

Establishing New Quality Jobs

Relocating New Quality Jobs

Location ___________________

Location (from where) ______________________

Location (to where) ________________________

D. LIST ALL INCENTIVES/INDUCEMENTS (INCLUDING ANY TAX CREDITS CURRENTLY IN PLACE

OR THAT WILL BE APPLIEDFOR THE PROJECT DURING THE PERIOD THAT THE TAXPAYER

CLAIMS THE NEW QUALITY JOBS TAX CREDIT.)

E. AT A MINIMUM, ATTACH A SCHEDULE WHICH PROVIDES THE INFORMATION BELOW FOR

ALL EMPLOYEES IN NEW QUALITY JOBS: (NOTE: WAGE MEANS AVERAGE WEEKLY WAGE,

AND INCLUDES BONUSES, INCENTIVE PAY, ETC. BUT DOES NOT INCLUDE CONTRIBUTIONS

MADE BY EMPLOYERS ON BEHALF OF EMPLOYEES TO HEALTH INSURANCE, RETIREMENT,

OR ANY OTHER BENEFIT PROGRAM.

Average

Employee Name

Percent above

Wages for the year for each employee

Social Security #

WeeklyWage

Year 1 County Avg.

(Please total this column at the bottom)

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Parent category: Financial