Form 500 - Individual Income Tax Return - 2000 Page 2
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1
2
3
4Form 500
2000
Social security number:
Page 2
Subtract either Line 11c or Line 12 from Line 10; enter balance.....................................
13.
13
,
,
.
14
Number from block on Line 6 ____multiplied by $2,700.................................................
14.
,
,
.
15
Georgia taxable income (Line 13 less Line 14 or Line 14, Schedule 3)...........................
15.
,
,
.
,
,
.
16
16.
Tax (Use Tax Table on Pages 9 and 10)....................................................................
Credits (
from Schedule 2, Page 3.....................
17
17.
,
,
.
Enter total but not more than the amount on Line16)
,
,
.
18
Balance (Line 16 less Line 17) If zero or less than zero, enter zero.........................
18.
19
,
,
.
19.
GEORGIA INCOME TAX WITHHELD (Attach withholding statements)............................
20
Estimated tax for 2000 and Form IT-500 PV.........................................................
,
,
.
20.
21.
21c
Low Income Credit (See worksheet on Page 11)
x 21b
21a
.........
,
,
.
22
Department use only........................................................................................................
,
,
.
22.
23
,
,
.
Total prepayment credits (Add Lines 19, 20, and 21C)......................................................
23.
24
,
,
.
If Line 18 exceeds Line 23 enter BALANCE DUE STATE................................................
24.
,
,
.
25
25.
If Line 23 exceeds Line 18 enter OVERPAYMENT amount...............................................
,
,
.
26
Amount to be credited to 2001 ESTIMATED TAX.............................................................
26.
27.
,
,
.
27
Georgia Wildlife Conservation Fund
.............................................
(No gift of less than $1.00)
28.
Georgia Children and Elderly Fund
...............................................
28
,
,
.
(No gift of less than $1.00)
29. Georgia Cancer Research Fund
......................................................
29
,
.
(No gift of less than $1.00)
,
30.
Form 500 UET (Estimated tax penalty).......................................................................
30
,
,
.
Add Lines 24, 27, 28, 29 and 30 (Balance due).........................................................
31.
31
,
,
.
MAKE CHECK PAYABLE FOR THIS AMOUNT TO GEORGIA INCOME TAX DIVISION
.
32
,
,
32.
Amount to be refunded. Line 25 minus Lines 26, 27, 28, 29 and 30 if applicable...........
GEORGIA INCOME TAX DIVISION
GEORGIA INCOME TAX DIVISION
OVERPAYMENTS
P.O. BOX 740380
P.O. BOX 740399
PAYMENTS AND OTHER
(REFUNDS)
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
SIGN
HERE
X
By initialing this box
SPOUSE’S SIGNATURE
I/We authorize the Georgia
DATE
Department of Revenue to
discuss this tax return with
X
the preparer named below.
SIGNATURE OF PREPARER IF OTHER THAN TAXPAYER
IDENTIFICATION NUMBER OF PREPARER
DATE
X
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