C-Corp, Trust, or Pass-Through Entity Donor FSA Tax Credit Application

C-Corp, Trust, or Pass-Through Entity Donor FSA Tax Credit Application

Apply for Georgia's Fostering Success Act tax credit through Brightside Child & Family Advocacy.
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.
I am filing my taxes this year as:
Application limit is up to 30% of Georgia income tax liability through June 30th, then unlimited if the credit fund has not reached the $30 million cap.
Are you an Insurance Company?
By selecting Yes, this application will be for a credit against the company's state insurance premium tax liability. The annual credit cap allowed to all insurance companies against state insurance premium tax liability is $10,000,000.
Entity Name
Must match FEIN registration
Federal Employer Identification Number (FEIN)
Example: 88-1234567 (please include the dash)
Contact Person Name

First NameMiddle NameLast Name
Contact Person Title
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
30% of Estimated GA Income Tax Liability (USD)
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 the 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 this contribution is made 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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