Instructions for Preparing  

                   Notice of Intent 
 
The Notice of Intent (NOI) is provided to assist businesses which are expanding or locating in 
the  state  and  whose  county  tier  is  reclassified  or  census  tract  area  is  removed  from  the  Less 
Developed Census Tract listing. Timely filing of the NOI will allow a business to continue to 
claim the tier or census tract classification in effect at the time the NOI is filed. Please note that 
                                                        st
the NOI must be filed with DCA no later than March 31  after the rankings are released in order 
to continue to claim the prior year ranking. (i.e. to preserve the 2021 ranking, the NOI must be 
filed with DCA no later than March 31, 2022.) 
 
Line 1 – Enter the name of the taxpayer creating jobs. 
 
Line 2 – Mailing address to which accepted Notice of Intent should be returned. 
 
Line 3 – Location address(es) in Georgia where jobs will be created. 
 
Line 4 – County or counties in Georgia where jobs will be created. Please note that multiple 
counties may be listed on the same form as long as they are all within the same tier. Different 
county tier locations must be listed on separate forms. 
 
Line  5  –   This  number  should  reflect  the  number  of  proposed  new,  full-time  jobs  that  the 
taxpayer  will  create  over  the  next  three  (3)  years  and  should  at  least  equal  the  tier  threshold 
required. (Note that the minimum job threshold must be met in a single tax year and that new, 
full-time  jobs  must  conform  to  the  applicable  definitions  found  in  the  Job  Tax  Credit 
Regulations.) 
 
Line 6 –The years listed should reflect the three (3) years of job creation for which the notice is 
submitted, not to exceed five (5) years from the submission date. 
 
Line 7 – List the most appropriate NAICS Code for the type of operation where jobs will be 
created and briefly describe the type of operation at the location where the jobs will be created. 
 
Complete only one to preserve the proper designation of the specified location: (a) to certify the 
county tier OR (b) to certify the less developed census tract.  
 - For the county tier, fill in (a) with the name of the county and the tier number.  
 - For the less developed census tract, fill in (b) with the census tract number. 
    
Please note that only (a) or (b) should be completed, depending upon whether the credit will be 
claimed  under  the  county  tier  designation  or  the  less  developed  census  tract  designation. 
Additional information on the Job Tax Credit Program and the Notice of Intent are available in 
the program regulations available on DCA’s web site at:  
https://www.dca.ga.gov/community-economic-development/incentive-programs/job-tax-credits

Rev. 12/2021                                                                                                 

                                           Notice of Intent 
                                            For  
                                   Georgia Job Tax Credit 
 
1.     Name of Company: _______________________________________________________ 
2.     Mailing Address of Company (where accepted form will be returned): _______________ 
     ________________________________________________________________________ 
3.     Location Address of Business Establishment Creating Jobs: _______________________ 
       ________________________________________________________________________ 
4.     Name of County in which Jobs will be Created: _________________________________ 
5.     Number of New, Full-time Jobs to be Created: __________________________________ 
6.     Year(s) in which Jobs will be Created: ________________________________________ 
       ________________________________________________________________________ 
7.     Type of Business Establishment (including NAICS Code): ________________________ 
       ________________________________________________________________________ 
 
Whereas the aforementioned company has abided by and will abide by all Job Tax Credit Program rules 
and  regulations,  application  is  hereby  made  to  the  Georgia  Department  of  Community  Affairs  for 
certification that the above location may qualify for the Job Tax Credit for new, full-time jobs in a: 
 
   (a) County Tier for  _______________ County* in Tier ______(if Tier 1: Ranked 1-40? Y or N);                                      OR 
   (b) Less Developed Census Tract for Census Tract  _____________* (Military Zone? Y or N)  
       whether or not the County or LDCT specified above retains its current designation. 
    
* Please complete only item (a) or (b) above, as this form will only apply to one designation, as completed above. 
 
__________________________                                  ______________________________ 
                    Date                                     Signature of Officer for above-named Company 
 
                                                            ______________________________ 
                                                                Legibly Print Officer’s Name 
                                                             
______________________________                              ______________________________ 
       Legibly Print Contact Name                                        Title of Officer 
 
______________________________                              ______________________________ 
                    Contact Email Address                            Contact Phone Number 
Please provide all appropriate contact information above in case we need to contact you about the information provided on this form. 
                                                   
                                           Department Use Only
Mailing Address:                                                     Accepted: 
Job Tax Credit Program Coordinator 
Georgia Department of Community Affairs 
60 Executive Park South, NE                                 _________________________________ 
Atlanta, GA 30329                                                      Date                                         
 
Or via email: 
oed@dca.ga.gov                                              ______________________________ 
                                                                         By 

Rev. 12/2021