Form It-Hq - Application For Georgia Headquarters Job Tax Credit Page 3
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IT-HQ
(REV 8/09)
C. PROJECT CATEGORY: (PLEASE CHECK ONE)
Established New Headquarters
Relocating Headquarters
Location ___________________
Location (from where) ______________________
Location (to where) ________________________
D. SUMMARY OF EXPENSES AT HEADQUARTERS(PLEASE NOTE THAT TOTAL INVESTMENT MUST EXCEED
$1 MILLION PRIOR TO USE OF THIS INCENTIVE)
1. Land Cost............................................................................... $ __________________________________
2. Building cost (new construction) ........................................... $ __________________________________
3. Purchase or Lease of Existing Facility Structure ................... $ __________________________________
4. Renovations or Improvements to Existing Structure.............. $ __________________________________
5. Office Furniture and Fixtures................................................. $ __________________________________
6. Machinery and Equipment..................................................... $ __________________________________
7. Other (please identify separately) .......................................... $ __________________________________
Total Headquarters Cost (by county)
E. 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 HEADQUARTERS JOB TAX CREDIT.)
F. AT A MINIMUM, ATTACH A SCHEDULE WHICH PROVIDES THE INFORMATION BELOW FOR
ALL HEADQUARTERS EMPLOYEES: (NOTE: WAGE MEANS AVERAGE WEEKLY WAGE, AND
INCLUDES BONUSES, INCENTIVE PAY, ETC.)
Employee Name
Social Security #
Wage
Percent above
Headquarters Duties
County Avg.
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Parent category: Financial