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PRINTCLEARForm ITWH (Rev. 12/16/20)This form must be filed electronically on the Georgia Tax Center (gtc.dor.ga.gov)NOTICE OF INTENTION TO CLAIM WITHHOLDING BENEFIT Name of Company AddressCityStateFederal Employer I.D.Georgia Withholding I.D. (s)Tax Year of Income Tax Return on which credit claimed:Anticipated Date of FilingQualifying Tax Credit:( ) Headquarters Job Tax Credit ( ) Job Tax Credit* ( ) Film Tax CreditZIP Code( ) Research Tax Credit** ( ) Quality Jobs Tax
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