Virginia Form Gjc - Application For Green Jobs Creation Tax Credit - 2016
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1
2
3Application for
VIRGINIA
Tax Year
Form GJC
Green Jobs Creation Tax Credit
_______
This credit must be approved before being claimed on your return.
Each location must file a separate application. See instructions for details.
Fiscal Year Filers: Begin Date
, and End Date
Name
Office Use Only
Trading As
Street Address
FEIN/SSN
City, State, ZIP Code
NAICS Code
Principal Business Locality
Description of Principal Business Activity
Individual
C Corporation
S Corporation
Entity Type:
(Check One)
Partnership
LLC
Other _____________________
If you applied for a Major Business Facility Job Tax Credit for the same tax year - STOP - you do not qualify for the Green Jobs Creation
Tax Credit.
Renewable, Alternative Energy Type: (Check One)
Hydrogen and Fuel Cell
Landfill Gas
Geothermal Heating Systems
Wind Systems
Solar Heating Systems
Hydropower Systems
Biomass and Biofuel Systems
Other _____________________
-
Part 1 - Credit Application
Complete the lines below and enclose GJC Schedule A
For each job that the credit is claimed, ALL of the following must apply:
1.
Each position applied for has been filled for at least one year;
2.
Each position applied for was a new position held in Virginia where each employee worked at least 1,680 hours; and
3.
Business has not been allowed (i) a Major Business Facility Job Tax Credit pursuant to Va. Code § 58.1-439 or (ii) a federal
tax credit for investments in clean energy manufacturing facilities that fosters the creation of any green job for the creation of
any job included in Part 2 of this application.
Part 2 - Tentative Credit Computation
1.
1.
Enter the number of new eligible green jobs created that have been filled for
12 consecutive months with an annual salary of at least $50,000. ..................................
2.
Enter the number of green jobs with an annual salary of at least $50,000 that were
2.
created within any of the 4 preceding taxable years, provided the job is continuously
filled during the taxable year for which the Green Jobs Creation Tax Credit is being
claimed. ............................................................................................................................
3.
Add Lines 1 and 2. If the total is less than 350, enter here. If the total is equal to or
3.
greater than 350, enter 350. .............................................................................................
Multiply Line 3 by $500. Enter here and on the Schedule CR, Section 1, Part 24, Line A
4.
4.
(individuals) or the 500CR, Section 1, Part 20, Line A (corporations). .............................
Part 3 - Declaration
I/we the undersigned declare, under the penalties provided by law, that this form (including any accompanying schedules, statements, and attachments)
has been examined by me/us and is, to the best of my/our knowledge and belief, a true, correct, and complete application, made in good faith pursuant
to the income tax laws of the Commonwealth of Virginia.
Authorized Signature
Title
Date
Printed Name
Phone Number
Email Address
Fax Number
File Form GJC and any supporting documentation at least 90 days prior to the due date of your return.
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