Form Gjc - Virginia Application For Green Jobs Creation Tax Credit
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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
Entity Type: (Check One)
Individual
C Corporation
S Corporation
Partnership
LLC
Other
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 eligible green jobs created during the taxable year and continuously
filled during the year 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 four 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
E-mail Address
FAX Number
File Form GJC and supporting documentation at least 90 days prior to the due date of your return.
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