Form 500 - Georgia Individual Income Tax Return - 2014 Page 4
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500
Georgia Form
Individual Income Tax Return
Georgia Department of Revenue
2014
YOUR SOCIAL SECURITY NUMBER
SCHEDULE 1 ADJUSTMENTS to INCOME BASED on GEORGIA LAW
(See Tax Booklet on Pages 11 and 12)
ADDITIONS to INCOME
.
00
1. Interest on Non-Georgia Municipal and State Bonds......................................
1.
.
00
2. Lump Sum Distributions.................................................................................
2.
.
00
3. Federal deduction for income attributable to domestic production activities......
3.
(IRC Section 199)
.
00
Other (Specify)
4.
4.
.
00
5. Total Additions (Enter sum of Lines 1-4 here)...............................................
5.
SUBTRACTION from INCOME
6. Retirement Income Exclusion (See Tax Booklet on Page 11)
a. Self: Date of Birth
Date of Disability:
Type of Disability:
.
00
6a.
Date of Disability:
Type of Disability:
b. Spouse: Date of Birth
.
00
6b.
.
00
7.
7. Social Security Benefits (Taxable portion from Federal return) ....................
.
00
8. Path2College 529 Plan................................................................................
8.
.
00
9. Interest on United States Obligations (See Tax Booklet on Page 11) .........
9.
10. Other Adjustments (Specify)
.
Adjustment
Amount
00
.
00
Adjustment
Amount
.
00
Adjustment
Amount
.
00
Adjustment
Amount
.
00
Total.................................
10.
.
00
11. Total Subtractions (Enter sum of Lines 6-10 here)........................................
11.
.
12. Net Adjustments (Line 5 less Line 11).
00
Enter Net Total here and on Line 9 of Page 2 (+ or -) of Form 500...............
12.
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