Individual or Married Filing Jointly Donor FSA Tax Credit Application

Individual or Married Filing Jointly Donor FSA Tax Credit Application

Thank you for supporting Brightside Child & Family Advocacy through Georgia's Fostering Success Act tax credit. Your gift supports young people who are aging out of, or have aged out of, Georgia's foster care system through our Brighter Futures program. Complete the form below and Brightside will apply for the tax credit pre-approval with the Georgia Department of Revenue on your behalf. If Brightside has already applied for the credit on your behalf this year, or you selected the wrong tax filing status, please go back and choose the correct application form.
Applicant and Filing Status
Filing Status
Taxpayer Name

First NameMiddle NameLast Name
Taxpayer Identification Number
Spouse Name

First NameMiddle NameLast Name
Spouse Identification Number
Contact and Address Information
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Contribution Details and Referral Source
Contribution Amount (USD)
For Tax Year
How did you hear about Brightside's FSA tax credit program?
Authorizations and Acknowledgement
Authorization to Submit Application
Acknowledgement of Donation and Purpose
Should be Empty: