Form It-Consv - Conservation Tax Credit Form
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STATE OF GEORGIA
Department of Revenue
Conservation Tax Credit
(This form is to be used by a taxpayer who donated property
for conservation purposes in a taxable year beginning on or after January 1, 2013)
IT-CONSV 2013 (10/12)
Tax Year End _____________________
A. Business Information of Taxpayer Donating Property
Federal Employer Identification Number/Social Security Number
Name
Type of Business:
Street Address
Partnership/LLC
Sole Proprietor
S Corporation
Other(Specify)
C Corporation
Individual
City
State
ZIP Code
Tax Year End
Telephone Number
E-mail Address
Contact Person
If Corporation please provide the state of incorporation
Date of Contribution
B. Recipient of Donated Property
Name of Governmental Entity or Organization ________________________________________________
Street Address _______________________________________ _________________________________
P. O. Box
City __________________________ State ____ ZIP Code _____________
Phone Number(s) ____________________
Fax Number ________________________
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