Form It-Hq - Application For Georgia Headquarters Job Tax Credit
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IT-HQ
(REV 8/09)
FOR DEPARTMENT USE ONLY
Project Number __________________
GEORGIA DEPARTMENT OF REVENUE
APPLICATION FOR GEORGIA
HEADQUARTERS JOB TAX CREDIT
Date Received____________________
Phone: (404) 417-2422 Fax: (404) 417-4303
Date Reviewed by ITD___________
This form must be attached to your return
Date Approved___________________
to claim the headquarters job tax credit.
Date Denied_____________________
Tax Year End______________
MM/DD/YY
Name of Applicant / Taxpayer (Legal Name)_________________________________________________________
Headquarters Address of Applicant / Taxpayer
What was the first date on which taxes
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such Headquarters?
__________________________________________ _____________________________________________
MM/DD/YY
What date did you establish or relocate your headquarters?
__________________________________________ _________________________________________________
MM/DD/YY
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What date were at least 50 persons employed in
(000) 000-0000
new full time jobs at new Headquarters?
Contact Person
__________________________________________ _________________________________________________
MM/DD/YY
On what date did you spend $1 million at
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__________________________________________ _________________________________________________
MM/DD/YY
A. TYPE OF BUSINESS (CHECK ONLY ONE BOX.)
Sole Proprietor (SSN) ______________
Partnership/LLC
C Corporation
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1) If Business is a Corporation, please list the state of incorporation: ______________________
2) Federal Employer ID Number: ____________________
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Parent category: Financial