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Contents

The Georgia 500 form is a crucial document for individuals filing their state income taxes in Georgia. This form captures essential information, including personal details such as names, addresses, and social security numbers. It also requires filers to indicate their residency status—whether they are full-year residents, part-year residents, or non-residents. The form outlines various filing statuses, allowing individuals to select the most appropriate category, whether single, married filing jointly, married filing separately, or head of household. Additionally, it includes sections for reporting income, deductions, and exemptions, which are vital for calculating the overall tax liability. Filers must report their federal adjusted gross income and make necessary adjustments to determine their Georgia adjusted gross income. The form also provides space for listing dependents, ensuring that all eligible exemptions are accounted for. Finally, it addresses tax credits, payments, and potential refunds, guiding taxpayers through the process of reconciling their tax obligations with any amounts already withheld. Completing the Georgia 500 form accurately is essential for compliance and can significantly impact a taxpayer's financial standing.

Georgia 500 Example

Georgia Form 500 (Rev. 08/02/21) Individual Income Tax Return

Georgia Department of Revenue

2021(Approved web2 version)

Please print your numbers like this in black or blue ink:

Page 1

Fiscal Year

Beginning

Fiscal Year

Ending

YOUR FIRST NAME

1.

STATE

ISSUED

YOUR DRIVER’S

LICENSE/STATE ID

MI

YOUR SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME (For Name Change See IT-511 Tax Booklet)

SUFFIX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPOUSE’S FIRST NAME

 

 

 

 

 

 

 

 

 

 

MI

 

SPOUSE’S SOCIAL SECURITY NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAST NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUFFIX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS (NUMBER AND STREET or P.O. BOX) (Use 2nd address line for Apt, Suite or Building Number) CHECK IF ADDRESS HAS CHANGED

2.

DEPARTMENT USE ONLY

CITY (Please insert a space if the city has multiple names)

STATE

ZIP CODE

3.

(COUNTRY IF FOREIGN)

 

ResidencyStatus

4. Enter your Residency Status with the appropriate number

4.

1. FULL- YEAR RESIDENT 2. PART- YEAR RESIDENT

TO

3. NONRESIDENT

Omit Lines 9 thru 14 and use Form 500 Schedule 3 if you are a part-year or nonresident filer.

 

 

 

Filing Status

 

5.

Enter Filing Status with appropriate letter (See IT - 511 Tax Booklet)

 

 

 

 

A.Single B.Marriedfilingjoint C.Marriedfilingseparate(Spouse’ssocialsecuritynumbermustbeenteredabove)

 

 

 

 

D.HeadofHouseholdorQualifyingWidow(er)

 

 

 

 

 

 

 

6.

Number of exemptions (Check appropriate box(es) and enter total in 6c.) 6a. Yourself

6b. Spouse

6c.

 

 

7a. Number of Dependents (Enter details on Line 7b., and DO NOT include yourself or your spouse)

 

7a.

 

 

 

 

PAGES (1-5) ARE REQUIRED FOR PROCESSING

Georgia Form 500

Individual Income Tax Return

Georgia Department of Revenue

YOUR SOCIAL SECURITY NUMBER

2021

Page 2

7b. Dependents (If you have more than 4 dependents, attach a list of additional dependents)

First Name, MI.

Social Security Number

First Name, MI.

Social Security Number

First Name, MI.

Social Security Number

First Name, MI.

Social Security Number

Last Name

Relationship to You

Last Name

Relationship to You

Last Name

Relationship to You

Last Name

Relationship to You

INCOME COMPUTATIONS

If amount on line 8, 9, 10, 13 or 15 is negative, use the minus sign (-). Example -3456.

.....................................8. Federal adjusted gross income (From Federal Form 1040)

8.

 

 

,

 

 

 

 

,.00

(Do not use FEDERAL TAXABLE INCOME) If the amount on Line 8 is $40,000 or more, or your gross income is less than your

 

 

 

W-2s you must include a copy of your Federal Form 1040 Pages 1, 2, and Schedule 1.

 

 

,

 

 

 

,

 

 

 

.

00

9. Adjustments from Form 500 Schedule 1 (See IT-511 Tax Booklet)

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

.00

.............................10. Georgia adjusted gross income (Net total of Line 8 and Line 9)

10.

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

..............11. Standard Deduction (Do not use FEDERAL STANDARD DEDUCTION)

11a.

 

 

 

 

 

,

 

 

 

.00

(See IT-511 Tax Booklet)

 

 

 

11b.

 

 

 

 

 

,

 

 

 

.00

b. Self: 65 or over?

Blind?

Total

 

x 1,300=

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spouse: 65 or over?

Blind?

 

 

 

11c.

 

 

 

 

 

,

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

c. Total Standard Deduction (Line 11a + Line 11b)

 

 

 

 

 

 

 

 

 

 

Use EITHER Line 11c OR Line 12c (Do not write on both lines)

12. Total Itemized Deductions used in computing Federal Taxable Income. If you use itemized deductions, you must include Federal Schedule A.

a. Federal Itemized Deductions (Schedule A- Form 1040)

12a.

b. Less adjustments: (See IT-511 Tax Booklet)

12b.

c. Georgia Total Itemized Deductions

12c.

13. Subtract either Line 11c or Line 12c from Line 10; enter balance

13.

 

 

 

,

 

 

 

,

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

,

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

,

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

 

,

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAGES (1-5) ARE REQUIRED FOR PROCESSING

Georgia Form 500

Individual Income Tax Return

Georgia Department of Revenue

YOUR SOCIAL SECURITY NUMBER

2021

Page 3

14a. Enter the number from Line 6c.

 

Multiply by $2,700 for filing status A or D 14a.

or multiply by $3,700 for filing status B or C

, .00

14b. Enter the number from Line 7a.

 

 

 

Multiply by $3,000

..........................................

14b.

 

 

 

 

14c. Add Lines 14a. and 14b. Enter total

 

 

 

 

 

14c.

15a. Income before GA NOL (Line 13 less Line 14c or Schedule 3, Line 14)

15a.

15b. Georgia NOL utilized (Cannot exceed Line 15a or the amount after

 

 

applying the 80% limitation, see IT-511 Tax Booklet for more information)

....15b.

15c. Georgia Taxable Income (Line 15a less Line 15b)

15c.

16.

Tax (Use Tax Table or Tax Rate Schedule in the IT-511 Tax Booklet)

16.

17.

Low Income Credit

17a.

 

 

17b.

 

 

........................

17c.

 

 

 

 

 

18.

Other State(s) Tax Credit (Include a copy of the other state(s) return)

18.

19.

Credits used from IND-CR Summary Worksheet

19.

20.Total Credits Used from Schedule 2 Georgia Tax Credits (must be filed 20. electronically)

21.

Total Credits Used (sum of Lines 17-20) cannot exceed Line 16

21.

22.

Balance (Line 16 less Line 21) if zero or less than zero, enter zero

22.

, .00

, .00

,, .00

,, .00

,, .00 ,, .00

.00

,, .00

,, .00

,, .00 ,, .00

INCOME STATEMENT DETAILS Only enter income on which Georgia tax was withheld. Enter income from W-2s, 1099s, and G2-As on Line 4 GA Wages/Income. For other income statements complete Line 4 using the income reported from Form G2-RP Line 12 or 13; Form G2-LP Line 11, or for Form G2-FL enter zero.

 

 

(INCOME STATEMENT A)

 

 

(INCOME STATEMENT B)

 

 

 

 

 

 

 

 

 

(INCOME STATEMENT C)

 

 

 

 

 

 

1.

WITHHOLDING TYPE:

 

 

 

 

 

 

 

 

 

 

 

1.

WITHHOLDING TYPE:

 

 

 

 

 

 

 

 

 

 

 

1.

WITHHOLDING TYPE:

 

 

 

 

 

 

 

 

 

 

 

 

W-2

 

 

G2-A

 

 

 

G2-LP

 

 

W-2

 

 

G2-A

 

 

 

 

G2-LP

 

 

W-2

 

 

G2-A

 

 

 

 

G2-LP

 

1099

 

 

 

G2-FL

 

 

 

G2-RP

 

1099

 

 

 

G2-FL

G2-RP

 

1099

 

 

 

G2-FL

G2-RP

2.

EMPLOYER/PAYER FEDERAL

2.

EMPLOYER/PAYER FEDERAL

 

 

 

 

 

 

 

2.

EMPLOYER/PAYER FEDERAL

 

 

 

 

 

 

 

ID NUMBER (FEIN)

SSN

 

ID NUMBER (FEIN)

 

SSN

 

 

 

 

 

 

 

 

ID NUMBER (FEIN)

 

SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. EMPLOYER/PAYER STATE WITHHOLDING ID

3.

EMPLOYER/PAYER STATE WITHHOLDING ID

3. EMPLOYER/PAYER STATE WITHHOLDING ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. GA WAGES / INCOME

 

 

 

 

 

 

 

 

 

.00

4. GA WAGES / INCOME

 

 

 

 

 

 

 

 

 

.00

4. GA WAGES / INCOME

 

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

,

 

 

 

 

 

 

,

 

 

 

 

 

 

,

 

 

 

 

 

 

 

,

 

 

 

 

 

 

,

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.GA TAX WITHHELD

,,

5.

GA TAX WITHHELD

 

 

 

 

 

5. GA TAX WITHHELD

 

 

 

 

.00

.00

 

 

,

 

 

 

,

 

 

 

.00

 

 

 

,

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE COMPLETE INCOME STATEMENT DETAILS ON PAGE 4.

PAGES (1-5) ARE REQUIRED FOR PROCESSING

Georgia Form 500

 

Individual Income Tax Return

 

Georgia Department of Revenue

YOUR SOCIAL SECURITY NUMBER

 

2021

Page 4

(INCOME STATEMENT D)

1.WITHHOLDING TYPE:

W-2 G2-A

1099 G2-FL

2.EMPLOYER/PAYER FEDERAL

ID NUMBER (FEIN)

 

SSN

 

 

 

(INCOME STATEMENT E)

1.WITHHOLDING TYPE:

G2-LP

W-2

G2-A

 

G2-RP

1099

G2-FL

 

2.

EMPLOYER/PAYER FEDERAL

 

ID NUMBER (FEIN)

 

 

 

SSN

 

 

 

 

 

 

 

 

 

(INCOME STATEMENT F)

1.

WITHHOLDING TYPE:

 

G2-LP

W-2

G2-A

 

G2-RP

1099

G2-FL

 

2.

EMPLOYER/PAYER FEDERAL

 

 

ID NUMBER (FEIN)

 

 

 

SSN

 

 

 

 

 

 

 

 

G2-LP

G2-RP

3. EMPLOYER/PAYER STATE WITHHOLDING ID

3.

EMPLOYER/PAYER STATE WITHHOLDING ID

3. EMPLOYER/PAYER STATE WITHHOLDING ID

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. GA WAGES / INCOME

 

 

 

 

 

 

 

 

.00

GA WAGES / INCOME

 

 

 

 

 

 

 

 

 

 

4. GA WAGES / INCOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

,

 

 

 

 

.00

 

 

 

,

 

 

 

 

 

 

,

 

 

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

GA TAX WITHHELD

 

 

 

 

.00

5. GA TAX WITHHELD

 

 

 

 

23.

 

 

,

 

 

 

,

 

 

 

 

 

 

,

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Georgia Income Tax Withheld on Wages and 1099s

23.

 

(Enter Tax Withheld Only and include W-2s and/or 1099s)

 

 

 

 

24.

Other Georgia Income Tax Withheld

 

 

 

 

 

 

24.

 

(Must include G2-A, G2-FL, G2-LP and/or G2-RP)

 

 

 

 

25. Estimated Tax paid for 2021 and Form IT-560

25.

26.

Schedule 2B Refundable Tax Credits

 

 

 

 

 

 

26.

 

(Cannot be claimed unless filed electronically)

 

 

 

 

27. Total prepayment credits (Add Lines 23, 24, 25 and 26)

27.

28. If Line 22 exceeds Line 27, subtract Line 27 from Line 22 and enter

 

 

 

 

 

balance due

 

 

 

 

 

 

 

 

 

 

 

28.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29. If Line 27 exceeds Line 22, subtract Line 22 from Line 27 and enter

 

 

 

 

 

overpayment

 

 

 

 

 

 

 

 

 

 

 

29.

30. Amount to be credited to 2022 ESTIMATED TAX

30.

31.

Georgia Wildlife Conservation Fund (No gift of less than $1.00)

31.

32. Georgia Fund for Children and Elderly (No gift of less than $1.00)

32.

33.

Georgia Cancer Research Fund (No gift of less than $1.00)

33.

34.

Georgia Land Conservation Program (No gift of less than $1.00)

34.

35.

Georgia National Guard Foundation (No gift of less than $1.00)

35.

36. Dog & Cat Sterilization Fund (No gift of less than $1.00)

36.

37.

Saving the Cure Fund (No gift of less than $1.00)

37.

38.

Realizing Educational Achievement Can Happen (REACH) Program

38.

 

(No gift of less than $1.00)

 

 

 

 

 

 

 

 

 

 

 

 

 

5.GA TAX WITHHELD

.00 ,,.00

,,.00

,,.00 ,,.00

,,.00

,,.00

,,.00

,,.00

,.00

,.00

,.00

,.00

,.00

,.00

,.00 ,.00

PAGES (1-5) ARE REQUIRED FOR PROCESSING

Georgia Form 500

Individual Income Tax Return

Georgia Department of Revenue

2021

Page 5

39.

Public Safety Memorial Grant (No gift of less than $1.00)

39.

40.

Form 500 UET (Estimated tax penalty) 500 UET exception attached

40.

41. (If you owe) Add Lines 28, 31 thru 40

41.

 

MAKE CHECK PAYABLE TO GEORGIA DEPARTMENT OF REVENUE..

 

Amount Due Mail To:

GEORGIA DEPARTMENT OF REVENUE

PROCESSING CENTER, PO BOX 740399

ATLANTA, GA 30374-0399

YOUR SOCIAL SECURITY NUMBER

,.00

,,.00 ,,.00

42. (If you are due a refund) Subtract the sum of Lines 30 thru 40 from Line 29

 

,

,

.00

THIS IS YOUR REFUND

42.

If you do not enter Direct Deposit information or if you are a first time filer you will be issued a paper check.

42a. Direct Deposit (U.S. Accounts Only)

Type: Checking

 

Routing

 

Number

 

 

 

Savings

 

 

Account

 

 

 

 

 

 

 

 

Number

Refund Due Mail To:

GEORGIA DEPARTMENT OF REVENUE PROCESSING CENTER, PO BOX 740380 ATLANTA, GA 30374-0380

INCLUDE ALL ITEMS IN ENVELOPE, DO NOT STAPL E YOUR CHECK, W-2s, OTHER WITHHOLDING DOCUMENTS, OR TAX RETURN.

I/We declare under the penalties of perjury that I/we have examined this return (including accompanying schedules and statements) and to the best of my/our knowledge and belief, it is true, correct, and complete. If prepared by a person other than the taxpayer(s), this declaration is based on all information of which the preparer has knowledge.

Taxpayer’s Signature

(Check box if deceased)

Spouse’s Signature

(Check box if deceased)

Taxpayer’s Date of Death

Spouse’s Date of Death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Taxpayer’s Signature Date

Taxpayer’s Phone Number

Spouse’s Signature Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By providing my e-mail address I am authorizing the Georgia Department of Revenue to electronically notify me at the below e-mail address regarding any updates to my account(s).

Taxpayer’s E-mail Address

Signature of Preparer

Name of Preparer Other Than Taxpayer

I authorize DOR to discuss this return with the named preparer.

Preparer’s Phone Number

Preparer’s FEIN

Preparer’s Firm Name

Preparer’s SSN/PTIN/SIDN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAGES (1-5) ARE REQUIRED FOR PROCESSING

Georgia Form500

(Rev. 08/02/21)

Schedule 1 Page 1

Schedule 1

Adjustments to Income

YOUR SOCIAL SECURITY NUMBER

2021(Approved web2 version)

SCHEDULE 1 ADJUSTMENTS to INCOME BASED on GEORGIA LAW

See IT-511 Tax Booklet

ADDITIONS to INCOME

1.

Interest on Non-Georgia Municipal and State Bonds

1.

2.

Lump Sum Distributions

2.

3.

Reserved

3.

4. Net operating loss carryover deducted on Federal return

4.

5.

Other (Specify)

5.

6.

Total Additions (Enter sum of Lines 1-5 here)

6.

,,.00

,,.00

,,.00

,,.00 ,,.00

SUBTRACTION from INCOME

7. Retirement Income Exclusion (See IT-511 Tax Booklet) Complete Schedule 1, page 2 if claiming Retirement Income Exclusion.

a. Self: Date of Birth

Date of Disability:

Type of Disability:

7a.

b. Spouse: Date of Birth

Date of Disability:

Type of Disability:

,.00

8.

Social Security Benefits (Taxable portion from Federal return)

8.

9.

Path2College 529 Plan

9.

10.

Interest on United States Obligations (See IT-511Tax Booklet )

10.

11.

Reserved

11.

12.

Other Adjustments (Specify)

 

7b.

,

,

,

,

.00

,

.00

,

.00

,

.00

 

Adjustment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjustment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjustment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount

 

Adjustment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

12.

 

13. Total Subtractions (Enter sum of Lines 7-12 here)

13.

 

14. Net Adjustments (Line 6 less Line 13). Enter Net Total here and on

 

 

 

 

Line 9 of Page 2 (+ or -) of Form 500 or 500X

14.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

,, .00

,, .00

,, .00

,, .00

,, .00

,,.00 ,,.00

Georgia Form500

Schedule 1

Page 2

(Rev. 08/02/21)

Schedule 1

Adjustments to Income

YOUR SOCIAL SECURITY NUMBER

2021(Approved web2 version)

SCHEDULE 1 RETIREMENT INCOME EXCLUSION

See IT-511 Tax Booklet

(TAXPAYER)

(SPOUSE)

1.Salary and wages......................................

2.OtherEarnedIncome (Losses).....................

3.TotalEarnedIncome....................................

4. Maximum EarnedIncome...........................

5.Smaller of Line 3 or 4; if zero or less, enter zero ..........................................................

6. Interest Income.........................................

7.DividendIncome .......................................

8.Alimony......................................................

9.CapitalGains (Losses)...............................

10. Other Income (Losses)..............................

(See IT-511 Tax Booklet)

11. Taxable IRA Distributions.........................

12. TaxablePensions .....................................

13.Rental,Royalty,Partnership, S Corp, etc. Income(Losses).....(See IT-511 Tax Booklet)

14.TotalofLines6through 13; if zero or less, enter zero ................................................

15.AddLines5 and14 ....................................

16.MaximumAllowable Exclusion* ..................

17.SmallerofLines15and16;enterhere and on Form 500, Schedule 1, Lines 7a. & b........

,,.00

,,.00 ,,.00

, 4 , 0 0 0 .00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00 ,,.00

,,.00

,,.00 ,,.00

, 4 , 0 0 0 .00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00

,,.00 ,,.00

*If age 62-64 or less than age 62 and permanently disabled enter $35,000, or if age 65 or older enter $65,000.

Georgia Form500

(Rev. 08/02/21)

Schedule 3 Page 1

Schedule 3

YOUR SOCIAL SECURITY NUMBER

Part-Year Nonresident

2021 (Approved web2 version)

DO NOT USE LINES 9 THRU 14 OF PAGES 2 AND 3 FORM 500 or 500X

SCHEDULE 3 COMPUTATION OF GEORGIA TAXABLE INCOME FOR ONLY PART-YEAR RESIDENTS AND NONRESIDENTS.

Income earned in another state as a Georgia resident is taxable but other state(s) tax credit may apply. See IT-511 Tax Booklet.

FEDERAL INCOME AFTER GEORGIA ADJUSTMENT

INCOME NOT TAXABLE TO GEORGIA

GEORGIA INCOME

(COLUMN A)

(COLUMN B)

(COLUMN C)

1.WAGES, SALARIES, TIPS,etc

,,

.00

1. WAGES, SALARIES, TIPS,etc

.00

1. WAGES, SALARIES, TIPS,etc

.00

 

 

 

,

 

 

 

,

 

 

 

 

 

 

,

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. INTEREST AND DIVIDENDS

 

2. INTEREST AND DIVIDENDS

.00

2. INTEREST AND DIVIDENDS

.00

 

 

,

 

 

 

,

 

 

 

.00

 

 

 

,

 

 

 

,

 

 

 

 

 

 

,

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. BUSINESS INCOME OR (LOSS)

3. BUSINESS INCOME OR (LOSS)

3. BUSINESS INCOME OR (LOSS)

,,

4.OTHER INCOME OR (LOSS)

.00 ,,.00 ,,.00

4. OTHER INCOME OR (LOSS)

4. OTHER INCOME OR (LOSS)

,

, .00 ,

,.00 ,

,.00

5. TOTAL INCOME: TOTAL LINES 1 THRU 4

5. TOTALINCOME: TOTAL LINES 1 THRU 4

5. TOTAL INCOME: TOTAL LINES 1 THRU 4

,

,

.00 ,

,.00 ,

,.00

6.

TOTAL ADJUSTMENTS FROM FORM 1040

6.

TOTAL ADJUSTMENTS FROM FORM 1040

6.

TOTAL ADJUSTMENTS FROM FORM 1040

 

 

 

 

 

,

 

 

 

,

 

 

 

.00

 

 

 

 

,

 

 

 

,

 

 

 

.00

 

 

 

 

,

 

 

 

,

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

TOTAL ADJUSTMENTS FROM FORM 500,

 

7.

TOTAL ADJUSTMENTS FROM FORM 500,

 

7.

 

TOTAL ADJUSTMENTS FROM FORM 500,

 

 

 

SCHEDULE 1

,

 

 

 

.00

 

 

SCHEDULE 1

,

 

 

 

.00

 

 

SCHEDULE 1

,

 

 

 

 

.00

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

ADJUSTED GROSS INCOME:

 

8.

ADJUSTED GROSS INCOME:

 

8.

 

ADJUSTED GROSS INCOME:

 

 

 

LINE 5 PLUS OR MINUS LINES 6AND 7

 

 

 

LINE 5 PLUS OR MINUS LINES 6AND 7

 

 

 

LINE 5 PLUS OR MINUS LINES 6 AND 7

 

,,.00 ,,.00

9. RATIO: Divide Line 8, Column C by Line 8, Column A enter percentage .......

10a. Itemized

 

or Standard Deduction

 

........................................................(See IT-511 Tax Booklet)

 

 

 

 

 

 

 

10b. Additional Standard Deduction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Self: 65 or over?

 

 

Blind?

 

Spouse: 65 or over?

 

Blind?

 

Total

 

X 1,300=

11. Personal Exemptions from Form 500 or Form 500X (See IT-511 Tax Booklet)

11a. Enter the number on Line 6c from Form 500 or Form 500X

 

multiply by $2,700 for

filing status A or D or multiply by $3,700 for filing status B or C

 

 

 

 

11b. Enter the number on Line 7a from Form 500 or Form 500X

 

multiply by $3,000 ..

12.Total Deductions and Exemptions: Add Lines 10a, 10b, 11a, and 11b

13.Multiply Line 12 by Ratio on Line 9 and enter result............................................

14.Income before GA NOL: Subtract Line 13 from Line 8, Column C

Enter here and on Line 15a, Page 3 of Form 500 or Form 500X....................................

 

 

 

 

 

,

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

.

 

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

% Not to exceed 100%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.00

 

 

 

 

,

 

10a.

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10b.

 

 

 

 

,

 

 

 

 

 

 

,

 

 

 

 

 

 

.

00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11a.

 

 

 

,

 

 

 

,

 

 

 

 

.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

.00

11b.

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

,

 

 

 

 

.00

12.

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.,,.00

14.,,.00

 

 

 

 

Page 1

 

 

Form IND-CR 201

 

 

State of Georgia Individual Credit Form

 

 

 

 

 

 

 

 

 

 

 

 

 

Georgia Department of Revenue

 

 

 

 

 

 

 

 

 

 

 

 

 

2021 (Rev. 08/02/21) (Approved web2 version)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

– Include with Form 500 or 500X, if this schedule is applicable.–

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR SOCIAL SECURITY NUMBER

 

SCHEDULE 201 Disabled Person Home Purchase or Retrofit Credit - Tax Credit 201

Disabled Person Home Purchase or Retrofit Credit - Tax Credit 201

O.C.G.A.§ 48-7-29.1 provides a disabled person credit equal to the lesser of $500 per residence or the taxpayer’s income tax liability for the purchase of a new single-family home that contains all of the accessibility features listed below. It also provides a credit equal to the lesser of the cost or $125 to retrofit an existing single-family home with one or more of these features.The disabled person must be the taxpayer or the taxpayer’s spouse if a joint return is filed. Qualified features are:

One no-step entrance allowing access into the residence. Interior passage doors providing at least a 32-inch-wide opening.

Reinforcements in bathroom walls allowing installation of grab bars around the toilet, tub, and shower, where such facilities are provided.

Light switches and outlets placed in accessible locations.

To qualify for this credit, the disabled person must be permanently disabled and have been issued a permanent parking permit by the Department of Revenue or have been issued a special permanent parking permit by the Department of Revenue.

This credit can be carried forward 3 years. For more information, see Regulation 560-7-8-.44.

1. Credit remaining from previous years

1.

2.Purchase of a home that contains all four accessibility features OR total of accessibility

features added to retrofit a home (up to $125 per feature) cannot exceed $500

 

per residence

2.

,

,

.00

.00

3. Credit used this tax year (enter here and include on IND-CR Summary Worksheet Line 1).3.

4. Potential carryover to next tax year (Line 1 plus Line 2 less Line 3)

4.

,. 00 ,. 00

 

 

 

 

Page 1

 

 

Form IND-CR 202

 

 

State of Georgia Individual Credit Form

 

 

 

 

 

 

 

 

 

 

 

 

Georgia Department of Revenue

 

 

 

 

 

 

 

 

 

 

 

 

2021 (Rev. 08/02/21) (Approved web2 version)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

– Include with Form 500 or 500X, if this schedule is applicable. –

YOUR SOCIAL SECURITY NUMBER

 

SCHEDULE 202 Child and Dependent Care Expense Credit - Tax Credit 202

Child and Dependent Care Expense Credit - Tax Credit 202

O.C.G.A. § 48-7-29.10 provides taxpayers with a credit for qualified child & dependent care expenses. The credit is a percentage of the credit claimed and allowed under Internal Revenue Code § 21 and claimed by the taxpayer on the taxpayer’s Federal income tax return. This credit cannot be carried forward. The credit is computed as follows:

1. Amount of child & dependent care expense CREDIT claimed on Federal Form 1040.

1.

 

 

 

,

 

 

 

.00

2.Georgia allowable rate ......................................................................................

3.Allowable Child & Dependent Care Expense Credit (Line 1 x .30)............................

4. Credit used this tax year (enter here and include on IND-CR Summary Worksheet

Line 2).....................................................................................................................

2.

3.

4.

30%

,.00

,.00

Document Breakdown

Fact Name Details
Form Purpose The Georgia Form 500 is used for filing individual income tax returns in the state of Georgia.
Governing Law This form is governed by the Georgia Public Revenue Code, specifically Section 48-2-31.
Filing Requirements All pages of the form (1-5) are required for processing. Incomplete submissions may delay your return.
Residency Status Filers must indicate their residency status as either full-year resident, part-year resident, or nonresident.
Filing Status Options Available filing statuses include Single, Married Filing Joint, Married Filing Separate, and Head of Household.
Exemptions Taxpayers can claim exemptions for themselves, their spouse, and dependents to reduce taxable income.
Standard vs. Itemized Deductions Taxpayers can choose between a standard deduction or itemized deductions, but not both.
Income Reporting Only income on which Georgia tax was withheld should be reported. This includes W-2s and 1099s.
Refund Process If a refund is due, it can be issued via direct deposit or paper check, depending on the information provided.
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