S-Corp Owner, LLC Member, or Partner Donor FSA Tax Credit Application

S-Corp Owner, LLC Member, or Partner 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 application form, please go back and choose the correct application form.
I am filing my taxes this year as:
NOTE: If your pass-through entity is filing and paying tax at the entity level, please use the C-Corp, Trust, or Pass-Through Entity application instead.
Are you an Insurance Company?
Taxpayer's Name

First NameMiddle NameLast Name
Social Security Number
Spouse Name (if applicable)

First NameLast Name
Spouse Social Security Number (if applicable)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Name(s) of Pass-Through Entity(ies)
Contribution Amount (USD)
For Tax Year
How did you hear about Brightside's FSA tax credit program?
I authorize Brightside Child & Family Advocacy to submit this application to the Georgia Department of Revenue (DOR) for pre-approval. Once DOR approval is received, I commit to fund my full approved contribution amount to Brightside Child & Family Advocacy within 60 days of the approval or by 12/31 of the same tax year, whichever comes first.
I understand I am donating directly to Brightside Child & Family Advocacy, a certified Qualified Foster Child Support Organization (QFCSO). Contributions support direct services for young people who have experienced foster care in Georgia.
Questions? Contact Brightside at 912-447-8908 or visit brightsideadvocacy.org.
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