Vision SSO Donor Form

Contributor Information

Contributor Tax Filing Status

Individual Filing Single or Head of Household (up to $2,500)Individual Filing Single and Owner of S-Corp, LLC, or Partnership (up to $25,000)C Corporation or Trust or Fiduciary (up to 75% of GA tax liability)Individual Filing Married Separate Return (up to $2,500)

Individual or Corporation IndividualCorporation

First Name* MI Last Name*

Tax Payer SSN/ITIN* SSN or ITIN* SSNITIN

Address* City*

State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code*

Email* Phone

Donation Information

Designated School* Preston Ridge MontessoriMcGinnis WoodsSugarloaf MontessoriLegacy Academy at Flynn CrossingLegacy Academy at Suwanee DamMedlock Bridge MontessoriJCMSOGMontessori at VickeryKids-R-KidsKiddie Academy of AlpharettaCrabapple Montessori- AlpharettaKiddie Academy of CummingHeadStart MontessoriGoddard - SuwaneeFulton Science AcademyStepping Stone Montessori- CummingMontessori Academy at Sharon SpringsTrillium MontessoriCreative Labs Learning CenterANY SCHOOL IS FINEOther Other School

Donation Amount*

Guidelines for the maximum contribution amount allowed are as follows
- For Individuals Filing As Single or Head of Household Up to $2,500
- For Individuals Filing A Married Joint Return Up to $5,000
- For Individuals Filing Married Separate Return Up to of $2,500
- Individual Owner of S-Corp, LLC, or Partnership Up to $25,000 ($50,000 if Spouse is also a pass-through owner), or your actual 2016 Georgia Tax Liability (whichever is less).
Georgia Tax liability is calculated as 6% of your net Georgia income from any pass-through ownership; If your net Georgia Income is estimated to be $100,000 in 2016, then the maximum donation that you can make for 2016 is $6000.
- C Corporation or Trust or Fiduciary Up to 75% of your GA Tax liability

I agree to allow Vision SSO, Inc., to use the information provided in this form to apply for approval from Georgia Department of Revenue (GADOR) to donate to the Qualified Education Expense Tax Credit Program. The approval of this application is up to GADOR based on accuracy of the information provided by me and availability of funds in the program. If GADOR approves my application, I commit to sending the full approved amount to Vision SSO, Inc., within 60 days of GADOR approval.*