Print
Clear
500
Fiscal Year
Georgia Form
(Rev. 9 /14)
Beginning
Individual Income Tax Return
Please print your numbers like this in black or blue ink:
Please print your numbers like this in black or blue ink:
Georgia Department of Revenue
Fiscal Year
2014
version)
(Approved web version)
Ending
DEL
EXT
YOUR FIRST NAME
MI
YOUR SOCIAL SECURITY NUMBER
1
Page
1.
LAST NAME
SUFFIX
Special Program Code
See Tax Booklet on Page 9
SPOUSE’S SOCIAL SECURITY NUMBER
SPOUSE’S FIRST NAME
MI
DEPARTMENT USE ONLY
LAST NAME
SUFFIX
CHECK IF ADDRESS HAS CHANGED
(Use 2nd address line for Apt, Suite or Building Number)
ADDRESS (NUMBER AND STREET or P.O. BOX)
2.
500 UET Exception
CITY (Please insert a space if the city has multiple names)
STATE
ZIP CODE
Attached
3.
(COUNTRY IF FOREIGN)
Residency Status
4. Enter your Residency Status with the appropriate number.................................................................................................................
4.
1. FULL- YEAR RESIDENT
2. PART- YEAR RESIDENT
TO
3. NONRESIDENT
Part-Year Residents and Nonresidents must omit Lines 9 thru 14 and use Schedule 3 of Form 500, page 6
Filing Status
5. Enter Filing Status with appropriate letter (See Tax Booklet Page 11 )..................................................................................
5.
A. Single
B.Married filing joint
C.Married filing separate(Spouse’s social security number must be entered above)
D. Head of Household or Qualifying Widow(er)
6. Number of exemptions (Check appropriate box(es) and enter total in 6c.)
6a. Yourself
6b. Spouse
6c.
7. Dependents (If you have more than 3 dependents, attach a list of additional dependents)
First Name, MI.
Last Name
Social Security Number
Relationship to You
First Name, MI.
Last Name
Social Security Number
Relationship to You
First Name, MI.
Last Name
Social Security Number
Relationship to You