Form 500 "Individual Income Tax Return" - Georgia (United States)

What Is Form 500?

This is a legal form that was released by the Georgia Department of Revenue - a government authority operating within Georgia (United States). As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 20, 2019;
  • The latest edition provided by the Georgia Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 500 by clicking the link below or browse more documents and templates provided by the Georgia Department of Revenue.

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500
Georgia Form
(Rev. 06/20/19)
Individual Income Tax Return
Georgia Department of Revenue
2019
(Approved web version)
1
Pag e
Fiscal Year
STATE
Beginning
Select
ISSUED
YOUR DRIVER’S
Fiscal Year
ver
Ending
LICENSE/STATE ID
YOUR FIRST NAME
MI
YOUR SOCIAL SECURITY NUMBER
1.
LAST NAME
(For Name Change See IT-511 Tax Booklet)
SUFFIX
SPOUSE’S SOCIAL SECURITY NUMBER
SPOUSE’S FIRST NAME
MI
DEPARTMENT USE ONLY
LAST NAME
SUFFIX
CHECK IF ADDRESS HAS CHANGED
ADDRESS (NUMBER AND STREET or P.O. BOX) (Use 2nd address line for Apt, Suite or Building Number)
2.
CITY (Please insert a space if the city has multiple names)
STATE
ZIP CODE
3.
(COUNTRY IF FOREIGN)
Residency Status
4. Enter your Residency Status with the appropriate number.................................................................................................................
4.
1. FULL- YEAR RESIDENT 2. PART- YEAR RESIDENT
TO
3. NONRESIDENT
Omit Lines 9 thru 14 and use Form 500 Schedule 3 if you are a part-year or nonresident filer.
Filing Status
5.
5. Enter Filing Status with appropriate letter (See I T - 511 Tax Booklet)....................................................................................
A. Single
B.Married filing joint C.Married filing separate(Spouse’s social security number must be entered above) D. Head of Household or Qualifying Widow(er)
6. Number of exempt ions (Check appropriate box(es) and enter total in 6c.)
6a. Yourself
6b. Spouse
6c.
7a.
7a. Number of Dependents (Enter details on Line 7b, and DO NOT include yourself or your spouse)........................ ..............
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500
Georgia Form
(Rev. 06/20/19)
Individual Income Tax Return
Georgia Department of Revenue
2019
(Approved web version)
1
Pag e
Fiscal Year
STATE
Beginning
Select
ISSUED
YOUR DRIVER’S
Fiscal Year
ver
Ending
LICENSE/STATE ID
YOUR FIRST NAME
MI
YOUR SOCIAL SECURITY NUMBER
1.
LAST NAME
(For Name Change See IT-511 Tax Booklet)
SUFFIX
SPOUSE’S SOCIAL SECURITY NUMBER
SPOUSE’S FIRST NAME
MI
DEPARTMENT USE ONLY
LAST NAME
SUFFIX
CHECK IF ADDRESS HAS CHANGED
ADDRESS (NUMBER AND STREET or P.O. BOX) (Use 2nd address line for Apt, Suite or Building Number)
2.
CITY (Please insert a space if the city has multiple names)
STATE
ZIP CODE
3.
(COUNTRY IF FOREIGN)
Residency Status
4. Enter your Residency Status with the appropriate number.................................................................................................................
4.
1. FULL- YEAR RESIDENT 2. PART- YEAR RESIDENT
TO
3. NONRESIDENT
Omit Lines 9 thru 14 and use Form 500 Schedule 3 if you are a part-year or nonresident filer.
Filing Status
5.
5. Enter Filing Status with appropriate letter (See I T - 511 Tax Booklet)....................................................................................
A. Single
B.Married filing joint C.Married filing separate(Spouse’s social security number must be entered above) D. Head of Household or Qualifying Widow(er)
6. Number of exempt ions (Check appropriate box(es) and enter total in 6c.)
6a. Yourself
6b. Spouse
6c.
7a.
7a. Number of Dependents (Enter details on Line 7b, and DO NOT include yourself or your spouse)........................ ..............
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500
Georgia Form
Individual Income Tax Return
Georgia Department of Revenue
2019
2
Pag e
YOUR SOCIAL SECURITY NUMBER
7b. Dependents (If you have more than 4 dependents, attach a list of additional dependents)
First Name, MI.
Last Name
Social Security Number
Relationship to You
SELECT
First Name, MI.
Last Name
Social Security Number
Relationship to You
SELECT
First Name, MI.
Last Name
Social Security Number
Relationship to You
SELECT
First Name, MI.
Last Name
Social Security Number
Relationship to You
SELECT
INCOME COMPUTATIONS
If amount on line 8, 9, 10, 13 or 15 is negative, use the minus sign (-). Example -3,456.
.
00
8. Federal adjusted gross income (From Federal Form 1040)................................... 8.
(Do not use FEDERAL TAXABLE INCOME) If the amount on Line 8 is $40,000 or more, or your gross income is less than your
.
W-2s you must include a copy of your Federal Form 1040 Pages 1, 2, and Schedule 1.
00
9. Adjustments from Form 500 Schedule 1 (See IT-511 Tax Booklet) ....................... 9.
.
00
10. Georgia adjusted gross income (Net total of Line 8 and Line 9)............................ 10.
.
00
11. Standard Deduction (Do not use FEDERAL STANDARD DEDUCTION).............. 11a.
.
(See IT-511 Tax Booklet)
00
b.
=......................... 11b.
Self: 65 or over?
Blind?
Total
x 1,300
.
00
Spouse: 65 or over?
Blind?
c. Total Standard Deduction (Line 11a + Line 11b)................................................... 11c.
Use EITHER Line 11c OR Line 12c (Do not write on both lines)
12. Total Itemized Deductions used in computing Federal Taxable Income. If you use itemized deductions, you must include Federal Schedule A.
.
00
a. Federal Itemized Deductions (Schedule A-Form 1040) ................................
12a.
.
00
b. Less adjustments (See IT-511 Tax Booklet) ..............................................
12b.
.
00
c. Georgia Total Itemized Deductions
..................................................................
12c.
.
00
13. Subtract either Line 11c or Line 12c from Line 10; enter balance.......................... 13.
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500
Georgia Form
Individual Income Tax Return
Georgia Department of Revenue
2019
3
Pag e
YOUR SOCIAL SECURITY NUMBER
.
00
Multiply by $2,700 for filing status A or D 14a.
14a. Enter the number from Line 6c.
o r multiply by $3,700 for filing status B or C....................................................
.
00
1 4b. Enter the number from Line 7a.
14b.
Multiply by $3,000...................................
.
00
14c. Add Lines 14a. and 14b. Enter total........................................................
1 4c.
.
00
15a.
15a. Income before GA NOL (Line 13 less Line 14c or Schedule 3, Line 14).....
.
00
15b.
15b. Georgia NOL utilized (cannot exceed Line 15a or the amount after
.
applying the 80% limitation, see IT-511 Tax Booklet for more information)....
00
15c.
15c. Georgia Taxable Income (Line 15a less Line 15b).....................................
.
00
16.
Tax (Use the Tax Table in the IT-511 Tax Booklet) ..........................................
16.
.
00
17a.
17b.
17. Low Income Credit
17c.
...........................
.
00
18. Other State(s) Tax Credit (Include a copy of the other state(s) return) ....
18.
.
00
19. C redits used from IND-CR Summary Worksheet .....................................
19.
,
,
.
00
20. Total Credits Used from Schedule 2 Georgia Tax Credits (must be filed 20.
.
electronically)
00
21.
21. Total Credits Used (sum of Lines 17-20) cannot ex ceed Line 16 ........ ... .................
.
00
22. Balance (Line 16 less Line 21) if zero or less than zero, enter zero ...........
22.
INCOME STATEMENT DETAILS Only enter income on which Georgia tax was withheld. Enter income from W-2s, 1099s, and G2-As on Line 4
GA Wages/Income. For other income statements complete Line 4 using the income reported from Form G2-RP Line 12 or 13; Form G2-LP Line
11, or for Form G2- . F L enter zero.
(INCOME STATEMENT A)
(INCOME STATEMENT B)
(INCOME STATEMENT C)
1.
1.
1.
WITHHOLDING TYPE:
WITHHOLDING TYPE:
WITHHOLDING TYPE:
W -2
W -2
W -2
G2-A
G2-LP
G2-A
G2-LP
G2-A
G2-LP
1099
1099
G2-FL
1099
G2-FL
G2-FL
G2-RP
G2-RP
G2-RP
2.
2.
2.
EMPLOYER/PAYER FEDERAL
EMPLOYER/PAYER FEDERAL
EMPLOYER/PAYER FEDERAL
ID NUMBER (FEIN)
SSN
ID NUMBER (FEIN)
SSN
ID NUMBER (FEIN)
SSN
3.
3.
3.
EMPLOYER/PAYER STATE WITHHOLDING ID
EMPLOYER/PAYER STATE WITHHOLDING ID
EMPLOYER/PAYER STATE WITHHOLDING ID
4.
4.
4.
GA WAGES / INCOME
GA WAGES / INCOME
GA WAGES / INCOME
.
.
.
00
00
00
5.
5.
GA TAX WITHHELD
5.
GA TAX WITHHELD
GA TAX WITHHELD
.
.
.
00
00
00
INCOME STATEMENT DETAILS CONTINUED ON PAGE 4.
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500
Georgia Form
Individual Income Tax Return
Georgia Department of Revenue
2019
4
Pag e
YOUR SOCIAL SECURITY NUMBER
(INCOME STATEMENT D)
(INCOME STATEMENT E)
(INCOME STATEMENT F)
1.
1.
1.
WITHHOLDING TYPE:
WITHHOLDING TYPE:
WITHHOLDING TYPE:
W- 2
W- 2
W- 2
G2-A
G2-LP
G2-A
G2-LP
G2-A
G2-LP
1099
1099
G2-FL
1099
G2-FL
G2-FL
G2-RP
G2-RP
G2-RP
2.
2.
2.
EMPLOYER/PAYER FEDERAL
EMPLOYER/PAYER FEDERAL
EMPLOYER/PAYER FEDERAL
ID NUMBER (FEIN)
SSN
ID NUMBER (FEIN)
SSN
ID NUMBER (FEIN)
SSN
3.
3.
3.
EMPLOYER/PAYER STATE WITHHOLDING ID
EMPLOYER/PAYER STATE WITHHOLDING ID
EMPLOYER/PAYER STATE WITHHOLDING ID
4.
4.
4.
GA WAGES / INCOME
GA WAGES / INCOME
GA WAGES / INCOME
.
.
.
00
00
00
5.
5.
GA TAX WITHHELD
5.
GA TAX WITHHELD
GA TAX WITHHELD
.
.
.
00
00
00
.
00
23. Georgia Income Tax Withheld on Wages and 1099s .............................
23.
(Enter Tax Withheld Only and include W-2s and/or 1099s)
.
00
24.
24. Other Georgia Income Tax Withheld ........................................................
(Must include G2-A, G2-FL, G2-LP and/or G2-RP)
.
00
25. Estimated Tax paid for 2019 and Form IT-560 .........................................
25.
,
,
.
26. Schedule 2B Refundable Tax Credits (cannot be claimed unless filed
26.
00
electronically)..........................................................................................
.
27. Total prepayment credits (Add Lines 23, 24, 25 and 26)...........................
27.
00
.
28. If Line 22 exceeds Line 27, subtract Line 27 from Line 22 and enter
00
28.
balance due...............................................................................................
.
29. If Line 27 exceeds Line 22, subtract Line 22 from Line 27 and enter
00
29.
overpayment ..............................................................................................
.
00
30. Amount to be credited to 2020 ESTIMATED TAX .................................
30.
.
00
31. Georgia Wildlife Conservation Fund (No gift of less than $1.00).............
31.
.
00
32. Georgia Fund for Children and Elderly (No gift of less than $1.00)........
32.
.
00
33. Georgia Cancer Research Fund (No gift of less than $1.00) .................
33.
.
00
34. Georgia Land Conservation Program (No gift of less than $1.00)...........
34.
.
00
35. Georgia National Guard Foundation (No gift of less than $1.00) .............
35.
.
00
36. Dog & Cat Sterilization Fund (No gift of less than $1.00) .......................
36.
.
37. Saving the Cure Fund (No gift of less than $1.00).................................
37.
00
.
00
38. Realizing Educational Achievement Can Happen (REACH) Program .............
38.
(No gift of less than $1.00)
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500
Georgia Form
Individual Income Tax Return
Georgia Department of Revenue
2019
5
Pag e
YOUR SOCIAL SECURITY NUMBER
.
00
39.
39.
Public Safety Memorial Grant (No gift of less than $1.00).......................
.
00
40. Form 500 UET (Estimated tax penalty)
500 UET exception attached
40.
.
41.
(If you owe) Add Lines 28, 31 thru 40
00
MAKE CHECK PAYABLE TO GEORGIA DEPARTMENT OF REVENUE. .
41.
Amount Due Mail To:
GEORGIA DEPARTMENT OF REVENUE
PROCESSING CENTER, PO BOX 740399
ATLANTA, GA 30374-0399
.
42.
00
(If you are due a refund) Subtract the sum of Lines 30 thru 40 from Line 29
42.
THIS IS YOUR REFUND.........................................................................
If you do not enter Direct Deposit information or if you are a first time filer you will be issued a paper check.
42a. Direct Deposit (U.S. Accounts Only)
Refund Due Mail To:
Routing
Type: Checking
GEORGIA DEPARTMENT OF REVENUE
Number
PROCESSING CENTER, PO BOX 740380
Account
Savings
ATLANTA, GA 30374-0380
Number
INCLUDE ALL ITEMS IN ENVELOPE, DO NOT STAPL E YOUR CHECK, W-2s, OTHER WITHHOLDING DOCUMENTS, OR TAX RETURN.
I/We declare under the penalties of perjury that I/we have examined this return (including accompanying schedules and statements) and to the best of my/our knowledge
and belief, it is true, correct, and complete. If prepared by a person other than the taxpayer(s), this declaration is based on all information of which the preparer has knowledge.
Georgia Public Revenue Code Section 48-2-31 stipulates that taxes shall be paid in lawful money of the United States, free of any expense to the State of Georgia.
(Check box if deceased)
Taxpayer’s Signature
(Check box if deceased)
Spouse’s Signature
Date
Date
Taxpayer’s Phone Number
I authorize DOR to discuss this return with the named preparer.
By providing my e-mail address I am authorizing the Georgia Department of Revenue to electronically notify me at the below e-ma il address regarding any updates to
my account(s).
Taxpayer’s E-mail Address
Preparer’s Phone Number
Signature of Preparer
Preparer’s FEIN
Name of Preparer Other Than Taxpayer
Preparer’s SSN/PTIN/SIDN
Preparer’s Firm Name
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