Department
Form 600-T
Use Only
Misc.
Department of Revenue
Income Tax Division
Change of
(Rev. 12/00)
Address
Exempt Organization Unrelated Business Income Tax Return
20
_____
(Under Georgia Code Section 48-7-25)
For the taxable year beginning___________, 20___________ and ending _____________, 20_____
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 trusts identification number.)
Number and Street
Date of current exemption letter and IRS code section under
City or Town, State and Zip Code
which you are exempt.
Name and Address of Trusts Fiduciary
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)...........................
SCHEDULE 2
COMPUTATION OF GEORGIA UNRELATED BUSINESS INCOME TAX
1. Line 5, Above X 6%........................................................................................
2. Less: Credits and Payments..........................................................................
3. Balance of tax due OR overpayment...................................................................
4. Interest due (see instructions)........................................................................
5. Penalties due (see instructions).....................................................................
6. Balance of tax, interest and penalties due with return.......................................
7. If line 3 above is an overpayment, amount is to be credited on 20_______
Estimated Tax
___________________
Refunded
___________________
A COPY OF THE FEDERAL 990-T AND SUPPORTING SCHEDULES (AND ANY EXTENSION) MUST BE ATTACHED TO THIS RETURN
DECLARATION: I/We declare, under penalties of perjury that I/we have have examined this return (including accompanying schedules and
statements) and to the best of our knowledge and belief it is true, correct, and complete. If prepared by a person other than taxpayer, his/her
declaration is based on all information of which s/he has any knowledge.
_________________________________
__________________________________
Signature of Officer
Signature of Individual or Firm Preparing Return
___________________
____________
_________________________________
Title
Date
Emp. Ident. or Social Security Number