Form 500 - Individual Income Tax Return - 2000 Page 3

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Form 500
2000 Schedule
Page 3
Social security number :
Name
:
SCHEDULE 1 ADJUSTMENTS TO INCOME BASED ON GEORGIA LAW (See Page 7 of instructions)
ADDITIONS TO INCOME
$
,
,
.
1. Interest on Non-Georgia Municipal and State Bonds..................................................................
$
2. Lump Sum Distributions..............................................................................................................
,
,
.
$
3. Other (Specify)...........................................................................................................................
,
,
.
4. Total Additions (Enter sum of Lines 1-3 here).............................................................................
$
,
,
.
SUBTRACTIONS FROM INCOME
5. Retirement Income Exclusion
Type of Disability:
(See Retirement income Exclusion worksheet, Page 13.)
$
,
.
Date of Disability
A. Self: Date of Birth
Type of Disability:
B. Spouse: Date of Birth
$
Date of Disability
,
.
6. Social Security Benefits (Taxable portion)...................................................................................
$
,
.
7. Railroad Retirement Benefits (Taxable portion)............................................................................
$
,
.
$
8. Interest on United States Obligations............................................................................................
,
,
.
(See Page 7 of instructions.)
$
9. Other (Specify).............................................................................................................................
,
,
.
$
10. Total Subtractions (Enter sum on Lines 5-9 here)........................................................................
,
,
.
$
11. Net Adjustments (Line 4 less Line 10, enter net total here and on Line 9 of Page 1) (+ or -)...............
,
,
.
SCHEDULE 2 CREDITS FOR LINE 17, PAGE 2
1. Other State Credit (See worksheet, Page 11)..............................................................................
$
,
.
2. Low Emission Vehicle Credit...............................................................................................................
$
,
.
3. Credits from Form IND-CR (Rural Physicians Credit, Disabled Person
$
Home Purchase or Retrofit Credit, and Qualified Caregiving Expense Credit).............................
,
.
4. Other Credits, Please Specify......................................................................................................
$
,
.
Pass Through Credits from Ownership of Sole Proprietor, S Corp., LLC, LLP or
Partnership Interest
$
,
.
5. Employer’s Credit for Basic Skills Education..................................................................................
Name of Business Entity________________________________________________
6. Employer’s Credit for Approved Employee Retraining....................................................................
$
,
.
Name of Business Entity________________________________________________
7. Employer’s New Jobs Credit..........................................................................................................
$
,
.
Name of Business Entity________________________________________________
8. Employer’s Credit for Providing or Sponsoring Childcare for Employees.......................................
$
,
.
Name of Business Entity________________________________________________
9. Manufacturer’s Investment Tax Credit...........................................................................................
$
,
.
Name of Business Entity________________________________________________
10. Optional Investment Tax Credit.......................................................................................................
$
,
.
Name of Business Entity________________________________________________
11. Other Credits, Please Specify........................................................................................................
$
,
.
Name of Business Entity________________________________________________
12. Enter the Total of Lines 1 through 11 here and
$
,
,
.
on Line 17, Page 2.......................................................................................................................

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