Georgia Form It-Qee-Tp1 - Qualified Education Expense Credit Preapproval Form Page 2
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Georgia Form IT-QEE-TP1
(Last Rev. 6 /12)
Qualified Education Expense Credit Preapproval Form
Taxpayer Identification Number
Version 2
Georgia Department of Revenue
B. ADDITIONAL INFORMATION FOR CONTRIBUTORS WHICH ARE SUBCHAPTER S CORPORATIONS
FOR GEORGIA PURPOSES, PARTNERSHIPS, OR LIMITED LIABILITY COMPANIES
The contribution limits for these entities are calculated separately for each shareholder, partner, or member.
As such on a separate schedule, the contributor must provide the following information for each shareholder,
partner, or member.
1. Name, address and taxpayer identification number
2. Type of taxpayer (i.e. corporation, individual, etc.)
3. If individual, filing status (joint, married filing separate, single, or head of household)
4. If individual filing a joint return, the name and identification number of the joint filer
5. If corporation or fiduciary, 75% of estimated GA income tax liability
6. Tax Year end
7. Profit/loss percentage
8. Amount of intended contribution allocated to each shareholder, partner, or member based on the profit/
loss percentage.
C. CERTIFICATION BY APPLICANT
Applicant certifies that all information contained above is true to his/her best knowledge and belief and is submitted
for the purpose of obtaining preapproval from the Commissioner.
Date:
Applicant:
Printed Name of Contributor (individual or entity)
Signature of Contributor (if an entity, an authorized officer or tax matters person)
If Contributor is an entity:
Printed Name and Title of Person Signing for Entity:
Name:
Title:
Phone Number:
Submit page 1 and page 2 to:
Georgia Department of Revenue
Qualified Education Expense Credit
1800 Century Blvd NE
Suite 8107
Atlanta, GA 30345
D. FOR DEPARTMENT USE ONLY
DATE RECEIVED
Based on the annual cap and your intended
contribution amount,
you have been preapproved and
.
,
,
00
allocated
of qualified education expense credit for
calendar
year
Approved by_________________________
Date
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