Form It-Qj - Georgia Department Of Revenue Application For Georgia Quality Jobs Tax Credit Page 8
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IT-QJ
(REV 10 /12)
J. CERTIFICATION BY APPLICATION
Applicant hereby certifies that all information contained above and in exhibits attached hereto are true
to his/her best knowledge and belief and that the taxpayer has abided by all New Quality Jobs requirements
in O.C.G.A § 48-7-40.17 and Revenue Regulation 560-7-8-.51.
Date: ____________________
Applicant:________________________________________
By: _____________________________________________
Signature of Authorized Officer
Title: ____________________________________________
Phone Number: ____________________________________
Subscribed and sworn to before me, a Notary Public in and for said County and State, this____day of ______, 20__.
My commission expi
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Resident of ______________________________ County
State of _________________________________
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