Form It-Consv - Conservation Tax Credit Form Page 3
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3IT-CONSV 2013 (10/12)
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Part IV Application of Credit and Carry Forward
1)
Amount of credit (from Line 2(d), Part II or Line 2(d), Part III) *
$ _____________________
2)
Credit Carried Forward from Prior Years **
$ _____________________
3)
Total Credit Available in the Current Year
$ _____________________
(Add Line 1 plus Line 2)
4)
Georgia Income Tax Liability for Current Year
$ _____________________
5)
Remaining Tax Credit
$ _____________________
(Line 3 less Line 4 – Not less than zero)
* The credit amount allowed for a taxable year shall not exceed $250,000 for an individual,
married couple filing a joint return, trust, or estate as determined under O.C.G.A. § 48-7-20 and
shall not exceed $500,000 for an entity as determined under O.C.G.A. § 48-7-21.
** The credit carry forward shall not exceed ten years (O.C.G.A. § 48-7-29.12(d)) and must be
reduced by any credit that is sold.
The taxpayer must add back to Georgia taxable income the amount of any federal charitable contribution
deduction taken on a federal return for which a Georgia Conservation tax credit is allowed. See Revenue
Regulation 560-7-8-.50 to determine the amount of the addback.
An Approved and Completed Certification Form from the Department of Natural Resources must be
attached to this Form.
A copy of the State Property Commission's determination must be attached to this form.
A copy of the appraisal must be attached to this form.
To be signed by Applicant
I endorse the accuracy of the information provided in this application. I affirm that the donated property is
not dedicated under local government regulation or ordinance, or dedicated to increase building density
levels under such regulations or ordinances.
I agree to provide any additional documentation requested by the Georgia Department of Revenue for
approval of this credit.
____________________________________________
_______________________________
Signature of Owner/Corporate Officer/or Individual
Date
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