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

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IT-QJ
(REV 10 /12)
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)
3

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