Form It-Qj - Georgia Department Of Revenue Application For Georgia Quality Jobs Tax Credit Page 2
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IT-QJ
(REV 10 /12)
B. CURRENT FINANCIAL INFORMATION:
1. Nature of business
2. NAICS Code (six digit level)
3. Describe the product(s) produced or service(s) provided
4. County / Tier _________________/_____________________
5. Projected payroll expense (annual)
6. Average weekly wage (of all new quality jobs) for tax year (see page 7 for information regarding the average wage for a taxable year.)
7. County Average Wage*:
Yr 1
Yr 2
Yr 3
Yr 4
Yr 5
Yr 6
Yr 7
_________ _________ _________ _________ _________ _________ _________
8. Percentage of amount on line 7 above County Average Wage*.
Yr 1
Yr 2
Yr 3
Yr 4
Yr 5
Yr 6
Yr 7
_________ _________ _________ _________ _________ _________ _________
9. Total payroll expense (of new quality jobs) ____________________________________
10. Legal Representative of Company. (If authorized to represent the Company, please include power of attorney.)
_________________________________________________
(Firm)
_________________________________________________
(Contact Name)
_________________________________________________
(Address)
_________________________________________________
C (
t i
) y
S (
t a t
) e
(ZIP)
_________________________________________________
(Phone Number)
* Fill in actual numbers for completed years only.
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