Georgia Form 500 -Individual Income Tax Return - 1999 Page 2
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4Page 2 Form 500 1999
Social Security Number
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Georgia Taxable Income (Amount from Line 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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16. Tax (Use Tax Table on pages 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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17. Credits (Enter total but not more than the amount shown on Line 16) From Schedule 2 page 3 . . . . . . . .
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18. Balance (Line 16 less Line 17) if zero or less than zero enter zero
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19. GEORGIA INCOME TAX WITHHELD (attach withholding statements) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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20. Estimated tax for 1999 and Form IT-560. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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21. Low Income Credit (See worksheet on page 11) ➤ 21a
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21c
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22. Department use only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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23. Total prepayment credits (Add Lines 19, 20, and 21C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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24. If Line 18 exceeds Line 23 enter BALANCE DUE STATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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25. If Line 23 exceeds Line 18 enter OVERPAYMENT amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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26. Amount to be credited to 2000 ESTIMATED TAX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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27. Georgia Nongame-Endangered Wildlife Conservation Fund. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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(No gift of less than $1.00 can be processed)
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28. Georgia Children and Elderly Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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(No gift of less than $1.00 can be processed)
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29. Form 500 UET (Estimated Tax Penalty) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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30. Add Lines 24, 27, 28, and 29 (Balance due). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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MAKE CHECK PAYABLE FOR THIS AMOUNT TO GEORGIA INCOME TAX DIVISION
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31. Amount to be refunded. Line 25 minus Lines 26, 27, 28, and 29 if applicable . . . . . . . . . . . . . . . . . . . . . .
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GEORGIA INCOME TAX DIVISION
GEORGIA INCOME TAX DIVISION
OVERPAYMENTS
P.O. BOX 740380
PAYMENTS AND OTHER
P.O. BOX 740399
ATLANTA, GEORGIA 30374-0380
ATLANTA, GEORGIA 30374-0399
Under penalty of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief
it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which the preparer has any knowledge.
YOUR SIGNATURE
DATE
DAYTIME PHONE NUMBER
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X
SPOUSE’S SIGNATURE
By initialing this box
I/We authorize the Georgia
DATE
SIGN
Department of Revenue to
discuss this tax return with
HERE
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X
the preparer named below.
SIGNATURE OF PREPARER IF OTHER THAN TAXPAYER
IDENTIFICATION NUMBER OF PREPARER
DATE
/
/
X
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