{"content":[{"text":"Please Return to: \n info@academicopportunity.org \n P.O. Box 26359 \n Phoenix, AZ 85068","bbox":{"left":0.579186,"top":0.069325,"width":0.296528,"height":0.08508399999999999}},{"text":"2022 AZ Corporate Income Premium Tax Credit Commitment \n or \n A.R.S. § 43-1183 or A.R.S. § 20-224.06 or A.R.S. § 43-1184 or A.R.S. § 20-224.07","bbox":{"left":0.115733,"top":0.196572,"width":0.767544,"height":0.04686599999999999}},{"text":"Name:","bbox":{"left":0.116912,"top":0.294786,"width":0.048048999999999994,"height":0.016652}},{"text":"Contact Name:","bbox":{"left":0.116912,"top":0.328666,"width":0.110502,"height":0.016652}},{"text":"Title:","bbox":{"left":0.540544,"top":0.328666,"width":0.03572299999999995,"height":0.016652}},{"text":"Phone:","bbox":{"left":0.116912,"top":0.362295,"width":0.05184699999999999,"height":0.016652}},{"text":"Email:","bbox":{"left":0.465034,"top":0.362295,"width":0.04451999999999995,"height":0.016652}},{"text":"Street Address:","bbox":{"left":0.117521,"top":0.395926,"width":0.111578,"height":0.016652}},{"text":"City / State / Zip:","bbox":{"left":0.117629,"top":0.427927,"width":0.12261300000000001,"height":0.016652}},{"text":"FEIN:","bbox":{"left":0.116912,"top":0.461777,"width":0.037318000000000004,"height":0.016652}},{"text":"S Corp (A.R.S. § 43-1089.04)","bbox":{"left":0.673581,"top":0.461777,"width":0.20274800000000004,"height":0.016652}},{"text":"Name & EIN of parent S Corp (if applicable):","bbox":{"left":0.116912,"top":0.495594,"width":0.32052499999999995,"height":0.016652}},{"text":"Check box if this corporation will be claiming the credit against insurance premium tax liability.","bbox":{"left":0.153204,"top":0.529064,"width":0.704293,"height":0.016652}},{"text":"NAIC (if applicable):","bbox":{"left":0.116912,"top":0.562854,"width":0.145831,"height":0.016652}},{"text":"Donation Amount ($):","bbox":{"left":0.116912,"top":0.597113,"width":0.162402,"height":0.016652}},{"text":": Please apply our donation towards Disabled and Displaced students in need","bbox":{"left":0.141485,"top":0.640112,"width":0.572989,"height":0.016652}},{"text":": Please apply our donation towards Low Income students in need","bbox":{"left":0.141485,"top":0.673742,"width":0.48905299999999996,"height":0.016652}},{"text":": Please apply our donation where it is most needed","bbox":{"left":0.141485,"top":0.707372,"width":0.383892,"height":0.016652}},{"text":"Signature:","bbox":{"left":0.098873,"top":0.766179,"width":0.08572499999999998,"height":0.016015}},{"text":"Date:","bbox":{"left":0.585161,"top":0.766096,"width":0.04387399999999997,"height":0.016015}},{"text":"Print Name:","bbox":{"left":0.098479,"top":0.799484,"width":0.096849,"height":0.016015}},{"text":"Title:","bbox":{"left":0.586541,"top":0.799913,"width":0.04176000000000002,"height":0.016015}},{"text":"Your request will be directly submitted to the Arizona Department of Revenue for approval and Academic Opportunity of \n Arizona will receive noti�cation within 20 days. Once approved, donation funds must be received by Academic Opportunity \n of Arizona via wire or check within 20 days. Don’t worry; we’ll let you know once your donation is approved and provide all \n necessary information moving forward. Thank you for choosing to partner with Academic Opportunity of Arizona!","bbox":{"left":0.09958,"top":0.837717,"width":0.790859,"height":0.06060399999999999}},{"text":"Impact | Opportunity | Community","bbox":{"left":0.3933,"top":0.960215,"width":0.27610500000000004,"height":0.016554999999999986}}],"images_bbox":[{"left":0.099349,"top":0.071788,"width":0.092834,"height":0.061713},{"left":0.327362,"top":0.948363,"width":0.052117,"height":0.035264}],"images_bbox_not_text_overlap":[{"left":0.099349,"top":0.071788,"width":0.092834,"height":0.061713},{"left":0.327362,"top":0.948363,"width":0.052117,"height":0.035264}]}