Form 600-T -Exempt Organization Unrelated Business Income Tax Return - 2016

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Mailing Address:

600-T

Georgia Department of Revenue

Georgia Form

(Rev. 09/12/16)

Processing Center

Exempt Organization

PO Box 740397

Unrelated Business Income Tax Return

Atlanta, Georgia 30374-0397

Page 1

Amended

Amended due to IRS Audit

Address Change

UET Annualization Exception attached

For the taxable year beginning ______________________, 20_______ and ending ______________________ , 20_______

Name of Fiduciary

Name of Organization

Federal Employer ID No. (in case of employees’

trust described in section 401 (a) and exempt under

section 501 (a), insert the trust’s identification number.)

Number and Street

City or Town

NAICS Code

Date of current

IRS code section

exemption letter.

for which you are

exempt.

State

Zip Code

State

Zip Code

SCHEDULE 1

1. Unrelated business taxable income from Federal Form 990-T (attach copy).........

2. Additions ...............................................................................................................

3. Total (add Line 1 and Line 2) ................................................................................

4. Subtractions ........................................................................................................

5. Georgia unrelated business taxable income (Line 3 less Line 4) ............................

COMPUTATION OF GEORGIAUNRELATED BUSINESS INCOME TAX

SCHEDULE 2

1. Line 5, above, multiplied by 6% ...........................................................................

2. Less: Credits used from Schedule 3, do not enter more than Line 1 of Schedule 2

3. Less: Payments ....................................................................................................

4. Withholding Credits (G2-A, G2-LP and/or G2-RP) ...............................................

5. Balance of tax due OR overpayment ....................................................................

6. Interest due (See Instructions) ..............................................................................

7. Underestimated tax penalty ...................................................................................

8. Other penalties due (See Instructions) ................................. . ................................

9. Balance of tax, interest and penalties due with return ...........................................

10. If Line 5 is an overpayment, amount to be credited on 20

Estimated Tax

Refunded

DECLARATION:

A COPY OF THE FEDERAL 990-T AND SUPPORTING SCHEDULES (AND ANY EXTENSION) MUST BE ATTACHED TO THIS RETURN.

I/We declare under penalty 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, 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.

Signature of Individual or Firm Preparing Return

Signature of Officer

Title

Date

Employee ID or Social Security Number