Film Tax Credit Page 3
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CLEAR
IT-FC 2013 (8/13)
C. Certification
Under penalty of perjury, I certify that the information provided to claim the Film Tax Credit under the
Georgia Entertainment Industry Investment Act is true and accurate to the best of my knowledge.
_____________________________
_________________________________________
Date
Signature of Corporate Officer, Partner, or Member
_________________________________________
Printed Name and Title
If this production company is a Qualified Interactive Entertainment Production Company, please provide
the name and FEIN Number for all your affiliates that are Qualified Interactive Entertainment Production
Companies (attach additional schedule if necessary).
Name of Entity
FEIN Number
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