Form It-Wh-Cep - Notice Of Intention To Claim Withholding Tax Benefit From Clean Energy Property Tax Credit

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Form IT-WH-CEP
(8/08)
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NOTICE OF INTENTION TO CLAIM
WITHHOLDING TAX BENEFIT FROM CLEAN ENERGY PROPERTY TAX
CREDIT* (FOR INSURANCE COMPANIES ONLY)
Name of Company
Address
City
State
Zip Code
Federal Employer I.D.
Georgia Withholding I.D. (s)
NAIC No:
Tax Year of Premium Tax Return on which credit claimed:
Anticipated Date of Filing
Whereas the aforementioned company has established a qualified tax credit to be applied to its Georgia Premium
Tax liability, and whereas the credit exceeds the premium tax liability, notice is hereby given of the company’s
irrevocable election to claim the excess of the premium tax credit as an offset to its Georgia Withholding Tax
payments paid under the provisions of Code Section 48-7-103 for this tax year.
If the aforementioned company does not want to use all of the excess of the tax credit as an offset to its Georgia
Withholding Tax payments, the aforementioned company can specify an amount of the excess to be used against
Georgia Withholding Tax payments. If the aforementioned company specifies an amount to be used against with-
holding the rest of the excess is premium tax carry forward. $ _________________________ amount to be used
against Georgia Withholding Tax payments.
Offsets to Withholding Tax payments may begin on the date specified by the Department of Revenue in Confirma-
tion of Intention to Claim Withholding Benefit letter, which the Department of Revenue will issue within 90 days
of the Office of Insurance and Safety Fire Commissioner receiving the Qualifying Year’s Georgia Premium Tax
Return or the due date of the return, whichever is later.
Date
Contact Person
Title
Phone Number
Email Address
Where to File this Form
This form must be filed with both the Department of Revenue and the Office of Insurance and Safety Fire
Commissioner at least 30 days prior to the due date of the Georgia premium tax return (including extensions)
or at least 30 days prior to the filing of the premium tax return, whichever occurs first. Please send to the
addresses below:
Department of Revenue
Office of Insurance and Safety Fire Commissioner
Withholding Tax Section
Suite 916 West Tower
P.O. Box 49431
2 Martin Luther King, Jr. Drive
Atlanta, GA 30359
Atlanta, GA 30334
*
For taxpayers preapproved to claim the clean energy property tax credit for calendar year 2012, 2013,
or 2014 the credit must be taken in four equal installments over four successive years.

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