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Georgia Form 500 (Rev. 06/20/20) Individual Income Tax Return

Georgia Department of Revenue

2020(Approved web version)

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

Page 1

Fiscal Year

Beginning

sion) Fiscal Year

Ending

YOUR FIRST NAME

STATE

ISSUED

YOUR DRIVER’S

LICENSE/STATE ID

YOUR SOCIAL SECURITY NUMBER

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

SUFFIX

SPOUSE’S FIRST NAME

SPOUSE’S SOCIAL SECURITY NUMBER

DEPARTMENT USE ONLY

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

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

STATE

ZIP CODE

(COUNTRY IF FOREIGN)

4. Enter your Residency Status with the appropriate number	ResidencyStatus
4. Enter your Residency Status with the appropriate number	4.

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

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)		.... 5.
5.			.... 5.
	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.

ALL PAGES (1-5) ARE REQUIRED FOR PROCESSING

Georgia Form 500

Individual Income Tax Return

Georgia Department of Revenue

YOUR SOCIAL SECURITY NUMBER

2020

Page 2

7b. Dependents (If you have more than 4 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
First Name, MI.	Last Name
Social Security Number	Relationship to You

INCOME COMPUTATIONS

If amount on line 8, 9, 10, 13 or 15 is negative, use the minus sign (-). Example -3,456.

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

,,.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.					,	,
9. Adjustments from Form 500 Schedule 1 (See IT-511 Tax Booklet)				9.	,	,
				9.
10. Georgia adjusted gross income (Net total of Line 8 and Line 9)				10.	,	,
11. Standard Deduction (Do not use FEDERAL STANDARD DEDUCTION)				11a.		,
(See IT-511 Tax Booklet)						,
b. Self: 65 or over?	Blind?	Total	x 1,300=	11b.		,
Spouse: 65 or over?	Blind?					,
c. Total Standard Deduction (Line 11a + Line 11b)				11c.		,

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

.00

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

ALL PAGES (1-5) ARE REQUIRED FOR PROCESSING

Georgia Form 500

Individual Income Tax Return

Georgia Department of Revenue

2020

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

YOUR SOCIAL SECURITY NUMBER

, .00

14b. Enter the number from Line 7a.			Multiply by $3,000		14b.		,	.00
14c. Add Lines 14a. and 14b. Enter total			......................................................		14c.		,	.00
15a. Income before GA NOL (Line 13 less Line 14c or Schedule 3, Line 14)					15a.	,	,	.00
15b. Georgia NOL utilized (Cannot exceed Line 15a or the amount after						,	,	.00
	applying the 80% limitation, see IT-511 Tax Booklet for more information)....				15b.	,	,	.00
15c. Georgia Taxable Income (Line 15a less Line 15b)					15c.	,	,	.00
16.	Tax (Use the Tax Table in the IT-511Tax Booklet)				16.	,	,	.00
17.	Low Income Credit	17a.	17b.	........................	17c.			.00
18. Other State(s) Tax Credit (Include a copy of the other state(s) return)					18.	,	,	.00
19. Credits used from IND-CR Summary Worksheet					19.	,	,	.00
20. Total Credits Used from Schedule 2 Georgia Tax Credits (must be filed					20.
	electronically)					,	,	.00
21. Total Credits Used (sum of Lines 17-20) cannot exceed Line 16				.............................	21.	,	,	.00
22.	Balance (Line 16 less Line 21) if zero or less than zero, enter zero				22.	,	,	.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					4. GA WAGES / INCOME					4. GA WAGES / INCOME
		,	,	.00			,	,	.00			,	,	.00
5.	GA TAX WITHHELD				5.	GA TAX WITHHELD				5.	GA TAX WITHHELD
		,	,	.00			,	,	.00			,	,	.00

PLEASE COMPLETE INCOME STATEMENT DETAILS ON PAGE 4.

ALL PAGES (1-5) ARE REQUIRED FOR PROCESSING


Georgia Form 500
Individual Income Tax Return
Georgia Department of Revenue																					YOUR SOCIAL SECURITY NUMBER
2020																					YOUR SOCIAL SECURITY NUMBER



				Page 4

				(INCOME STATEMENT D)								(INCOME STATEMENT E)										(INCOME STATEMENT F)
	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								4. GA WAGES / INCOME								4. GA WAGES / INCOME
							,		.00						,		.00								,
					,								,										,					.00
					,								,										,					.00
	5.		GA TAX WITHHELD							5.	GA TAX WITHHELD							5.	GA TAX WITHHELD
					,		,		.00				,		,		.00						,		,			.00


23.		Georgia Income Tax Withheld on Wages and 1099s														23.							,		,			.00
23.		Georgia Income Tax Withheld on Wages and 1099s														23.
			(Enter Tax Withheld Only and include W-2s and/or 1099s)
			(Enter Tax Withheld Only and include W-2s and/or 1099s)
24.			........................................................Other Georgia Income Tax Withheld													24.							,		,			.00
			(Must include G2-A, G2-FL, G2-LP and/or G2-RP)
			(Must include G2-A, G2-FL, G2-LP and/or G2-RP)
25.			Estimated Tax paid for 2020 and Form IT-560													25.							,		,			.00
25.			Estimated Tax paid for 2020 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 2021 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)

.00

ALL PAGES (1-5) ARE REQUIRED FOR PROCESSING

Georgia Form 500

Individual Income Tax Return

Georgia Department of Revenue

2020

Page 5

39.	Public Safety Memorial Grant (No gift of less than $1.00)
40.	Form 500 UET (Estimated tax penalty)	500 UET exception attached

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

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

39.

40.

41.

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

Savings

Routing Number

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. Georgia Public Revenue Code Section 48-2-31 stipulates that taxes shall be paid in lawful money of the United States, free of any expense to the State of Georgia.

Taxpayer’s Signature

(Check box if deceased)

Date

Taxpayer’s Phone Number

Spouse’s Signature

Date

(Check box if deceased)

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

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

Preparer’s Phone Number

Signature of Preparer

Name of Preparer Other Than Taxpayer

Preparer’s FEIN

Preparer’s Firm Name

Preparer’s SSN/PTIN/SIDN

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Question	Answer
Form Name	Georgia Form 500
Form Length	19 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	4 min 45 sec
Other names	2015 georgia 500 fillable, fillable 2015 georgia tax form 500, printable georgia form 500, georgia form 500 2015

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