Form Gjc - Application For Green Jobs Creation Tax Credit
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1
2
3Tax Year ___________
VIRGINIA
Application for
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
Entity Type: (Check One)
Individual
C Corporation
S Corporation
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. Attach a list of qualifying jobs including job title, locality code, annual salary
and a brief description.
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. Enter the number of new eligible green jobs created that have been filled for twelve
consecutive months with an annual salary of at least $50,000. ...........................................
1.
2. Enter the number of green jobs with an annual salary of at least $50,000 continuously
filled during the taxable year for which a Green Jobs Creation Tax Credit was claimed
during any of the 4 preceding taxable years.........................................................................
2.
3. Add Lines 1 and 2 and enter the total. If the total is less than 350, enter here. If the total is
equal to or greater than 350, enter 350. ..............................................................................
3.
4. Multiply Line 3 by $500 and enter here and on Part 24, Line A of Schedule CR. ................
4.
Part 3 - Declaration
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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