Georgia Individual Income Tax Return Form
In the case of a resident of the State of Georgia wanting to submit his/her income tax returns, the following form has to be completed and submitted.
Download
Extracted Text for Proper Search
2 0. Other Georgia Income Tax Withheld ................................................
9. A dju stm ents f r o m S ch edu le 1 ( S ee Ta x B ookle t o n P age 1 1 , L in e 9 )........
1 0. G eorg ia a d ju ste d g ro ss i n co m e ( N et t o ta l o f L in e 8 a nd L in e 9 )... .. . ... ... .. .
1 1 . S ta nda rd D ed uctio n
(D o n ot u se F E D ER AL S TA N DAR D D ED UCTIO N) . .....
Georgia Form 500 In div id ual In co m e T a x R etu rn
Georgia Department of Revenue
20 12
1 8. Balance (Line 16 less Line 17) if zero or less than zero, enter zero.......
1 3. S ubtr a ct e it h er L in e 1 1 c o r L in e 1 2c f r o m L in e 1 0; e nte r b ala nce .
...... .......
(Enter total but not more than the amount on Line 16)........................
1 4
a. Number on Line 6c. multiplied by $2,700..................................... 14a.
14 b. Number on Line 7a. multiplied by $3,000..................................... 14b.
1 4c. A dd L in es 1 4a. a nd 1 4b. E nte r t o ta l...................................................... 1 4c.
1 5. Georgia t axable income
(Line 13 less Line 14c or S chedule 3, Line 14 ) ...........
1 6. Ta x ( U se T a x T a ble i n t h e T a x B ookle t o n P ages 2 0-2 2)................... ... .....
1 7. Cre d it s f r o m S ch edu le 2 , P age 5 , L in e 1 2 o f F orm 5 00
7a.
7 b. A dd L in es 6 c a nd 7 a. E nte r t o ta l................................................................................. ... .... .. ............................................. ... .... ..
7
a. N um be r o f D epe nden ts ( D O N O T i n clu d e y o urs e lf o r y o ur s p o use ).. .... ... . ....... . ....... . ....... . ....... . ....... . ....... . .... . . .... .. . ..... ... . ....... ..
(See Tax Booklet on Page 12 Line 11 )
12. T ot al I te m iz e d D ed uctio ns u se d i n c o m putin g F edera l T a xa ble I n co m e. I f y o u u se i t e m iz e d d eductio ns, y o u m ust e n clo se F ed era l S ch ed ule A
I N CO M E
STE P 3
D EDUC TIO NS
S
TE P 4
T A X C O M PU TA TIO N
S TE P 5
Y O UR S O CIA L S EC URIT Y N UM BER
STEP 2 CONT .
2 Pag e
7b.
8. F edera l a dju ste d g ro ss i n co m e (F ro m F edera l F orm 1 04 0,1 04 0A o r 1 040 E Z).
If amount on line 8, 9 , 10, 13 or 15 is negative, use the minus sign (\
-). Example -3,456.
8.
you must enclose a copy of your Federal Form 1040 Pages 1 and 2.
(Do
not use FEDERAL T AXABLE INCOME) If the amount on Line 8 is $40,000 or more, or your gross income is less than your W-2’ s
1 7.
1 8.
1 9.
2 0.
1
6.
1
5.
a . F edera l I te m iz e d D edu ctio ns ( S ch edu le A -F orm 1 040) ............... ......
b . L ess a dju st m ents : ( S eeTa x B ookle t o n P age 1 3, L in e 1 2) .............. ..
12a .
13.
12c.
1
2b.
c. G eorg ia T ot al It em iz e d D ed uct io ns .. . ... . ... . ... ... . .... ... . .... . .... ... . .... ... . .... ....
c . T ot al S ta nda rd D edu ctio n ( L in e 1 1 a + L in e 1 1 b).......................... .. .....
b .
Self: 65 or over? Blind? Spouse: 65 or over? Blind?
T o tal x 1,300
=.........
Use EITHER Line 11c OR Lin e 12c (Do n ot w rite o n b oth lines ) 11 c.
1
1 b.
1
1 a.
1 0.
9
.
00.
.
00
0 0
00
.
.
.
00
.00
.00
Georgia Income Tax Withheld on Wages and 1099’s .....................
(Enter Tax Withheld Only and enclose W-2s and/or 1099s) 1 9.
(Must enclose G2-A, G2-LP and/or G-2RP)
V ers io n 1
.
0 0
0 0
00
.
.
.
00
.00
.
00
0 0
00
.
.
.
00
00.
00.
00.
22. Tot al p re pa ym ent c re dit s ( A dd L in es 1 9, 20 and 21)...................................
2 3. If L in e 1 8 e xce eds L in e 2 2 e nte r B ALA N CE D UE STATE
2 4. If L in e 2 2 e xce eds L in e 1 8 e nte r O VERPAYMENT amount
2 5. Am ount t o be c re dit ed t o 2 013 ESTIMATED TAX . ... .. ... .. .. .. ... ... ... .. ... .. ... ..
2 6. Georg ia W ild lif e C onse rv a tio n F und ( N o g if t o f l e ss t h an $ 1.0 0).... . .... .. .. .. .. .
2 7. Georg ia C hil d re n a nd E ld erly F und ( N o g if t o f l e s s t h an $ 1.0 0).. .. .. .. ... ... .. ... .
2 8. Georg ia C ance r R ese arc h F und ( N o
g if t o f l e ss t h an $ 1.0 0)................. .....
2 9. Sta te w id e L and C onse rv a tio n P ro gra m ( N o g if t o f l e ss t h an $ 1.0 0)......... ...
3 0. Georg ia N atio nal G uard F ounda tio n ( N o g if t o f l e ss t h an $ 1.0 0)........ .........
3 1. Dog & C at S teriliz atio n F un d ( N o g if t o f l e s s t h an $ 1 .0 0 )...........................
3 6a. Direct
Deposit (For U.S. Accounts Only)
Typ e: C
he cking S avin gs
Georgia Form 500 In div id ual In co m e T a x R etu rn
Georgia Department of Revenue
Save the Cure Fund (No gift of less than $1.00).........................................
33. Georgia Student Finance Authority Fund (No gift of less than $1.00).........
MAKE C HEC K P A YA BLE T O G EO RG IA D EPA RTM EN T O F R EVEN UE ... .........
3 6.
( If y ou are due a refund ) Subt ract the sum of Lines 25 thru 34 from Line 2 4
Y O UR SOCIAL SECURITY NUMBER
STE P 6
S TE P 5
TA X C O M PU TA TIO N C O NTIN UED
S
IG NATU RE
P ag e 3
.
00.
00
0
0
00
0 0
0 0
0 0
0 0
0 0
0 0
0 0.
. .
.
.
.
. .
.
0
0.
00. .
00
00
2 4.
F orm 5 00 U ET ( E stim ate d t a x p en alt y )................................................ ... ...... 3
4.
3
3.
34. 2
2.
2 7.
2
5.
2 6.
2
3.
2 8.
2 9.
3 0.
3 1.
32.
3 2.
2 0 12
3 5.
THIS IS YOUR REFUND .................................................... ... ... ...
( If y o u o w e) A dd L in es 2 3 , 2 6 th ru 3 4
36.
3
5.
PHONE NUMBER
DATE
P R EPA RER ’S S SN /P TIN
P
R EPA RER ’S F E IN
D ATE
2 1. Estimated tax for 2012 and Form IT-560
PH O NE N UM BER
T a xp ayer ’s Signature
Signature of Preparer (C heck b ox if d ece ase d)
S pouse ’s Signature (Check box if deceased)
NAM E O F P R EPA RER O TH ER T H AN T A XPA Y ER
Do you want to authorize DOR to discuss this return with the
named preparer.
Yes
TA XPA Y ER E M AIL
A DD RESS
E N C LO SE A LL I T E M S I N R ETU R N E N VELO PE .D O N O T S TA PLE Y O UR C H EC K, W -2 ’S, OTHER WITHHOLDING DOCUMENTS, OR TAX RETURN
D EPO SIT O PTIO NS
I authorize the Georgia Department of Revenue to
e le ctr oni cally no tif y m e a t th e b elo w e -m ail a dd re ss
regarding any updates to my account(s).
Num ber
N um ber
S ele ct o nly o ne o ptio n - S ee b ookle t p ag e 1 3.
36c. P
ap er C hec k
3 6b . D eb it C ard
R outin g
A cc o un t
G EO RG IA D EPA RTM EN T O F R EVEN UE
P O B O X 740399 A TLA NTA , G A 3 037 4-0 399
G re e n L ab el:
( P A Y M EN T
) P
R O CESSIN G C EN TE R
GEO RG IA D EPA RTM EN T O F R EVEN UE
P O B O X
740380 A TLA NTA , G A 3 037 4-0 380
P
R O CESSIN G C EN TE R
Blue Label:
(REFUND and NO
BALANCE DUE)
0
0 ................................................ ..... 2
1. .
.
.......................... .....
...................... .....
Under
penalty of perjur y, I declare that I have examined this return, including accomp anying schedules and statement s, and to the best of my knowledge and belief it is
true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Georgia Public Code Section
48-2-31 requires that taxes shall be paid in lawful money of the United States, free of any expenses to the State of Georgia.
V ers io n 1
Y ou c a n h elp e lim in ate $ 1 M illi o n
o f p ro ce s s in g c o st b y c h oosin g
D ir e c t D ep osit o r D eb it C ard .
Georgia Form 500 In div id ual In co m e T a x R etu rn
Georgia Department of Revenue
20 12
A DD IT IO NS t o I N CO M E
1. I n te re st o n N on-G eorg ia M unic ip a l a nd S ta te B onds.............................. ... .....
2 . L um p S um D is tr ib utio ns......................................................................... ... .....
3. F edera l d edu ctio n f o r i n co m e a ttr ib u ta ble t o d om estic p ro du ctio n a ctiv it ie s ......
7 . S ocia l S ecu rit y B enefit s ( T a xa ble p ortio n f r o m F edera l r e tu rn ).............. ......
8 . G eorg ia H ig h er E duca tio n S avin g s P la n................................................. ... ....
9 . Interest on United S tates Obligations (See Tax Booklet
on Page 11) ......... 9.
A dju stm ent Amount
Adjustment Amount
Adjustment Amount
Ad ju stm ent Amount
1 1 . T o ta l S ubtr a ctio ns ( E nte r s u m o f L in es 6 -1 0 h ere ).................................. ... ...
1 2. N et A dju stm ents ( L in e 5 l e ss L in e 1 1).
En ter Net T ot al her e and o n Lin e 9 of Page 2 (+ or -) of Fo rm 50 0...............
5 . T o ta l A ddit io ns ( E nte r s u m o f L in e s 1 -4 h ere )........................................ .. ..... 2
.
00.
00.
00.
00.
00
S U BTR ACTIO N f r o m I N CO M E
To ta l. ... .. ... ... .. ... ... ... .. ... .. ...
S C HED ULE 1 A DJU STM EN TS t o I N CO M E B ASED o n G EO RG IA L A W (s e e T a x B ookle t o n P ages 1 1 a nd 1 2)
.
10. O th er A dju stm en ts ( S pecif y )
Other (Specify)
(IRC Section 199) 3
.
1
.
4 .
00
0 0
0 0
0 0
0 0
..
.
.
T yp e o f Di sa bilit y :
D ate o f Di sa bilit y :
a. Self: Date of Birth
6. R etir e m ent I n co m e E xclu sio n ( S ee Ta x B oo kle t o n P age 1 1 )
.
00. 6 a.
00.
00.
00.
Y O UR S O CIA L S EC URIT Y N UM BER
00.
00.
00.
5 .
1 2.
D ate o f Di sa b ilit y :
T yp e o f Di sa bilit y :
b . S pouse : D ate o f B ir th
6 b.
4 P ag e
4.
8.
7
.
1 0.
1 1 .
V ers io n 1
1 . O th er S ta te C re dit ( s ) T a x C re dit ( S ee T a x B ookle t o n P age 1 5).................. .......
2 .
5 . C le an E nerg y P ro pe rty C re d it ( In div id ua l/ N on p ass t h ro ugh).................... ... ....
Pass Through Credit s from Ownership of Sole Proprietor , S Corp., LLC or Partnership Interest and Other Credits
Y ou m ust l is t t h e app ro pria te C re d it T yp e C ode i n t h e s pa ce p ro vid e d. I f y o u c la im m ore t h an f o ur c re dit s , e nclo se a s ch ed ule .
E nte r t h e s ch edu le t o ta l o n L in e 1 0. S ee T a x B ookle t o n P age 1 6 f o r a l is t o f av aila ble c re dit s a nd t h eir a pplic a ble c o de s.
4 . Q uali f ie d E duca tio n E xp ense C re d it ( Indi vid ual/ N on p ass t h ro ugh).......... .......
1 1. Low Income Credit (See Tax Booklet). 11a. 1 1b. ................................................... . 1 1c.
1 2.
Enter the total of Lines 1 through 11 here and on Line 17, Pg. 2 of 500 form... 12.
A doptio n C re dit , E lig ib le S in gle -F am il y Re sid ence C re dit ) .......................... ... ....
a nce C re dit , Q ualif ie d Car eg iv in g E xp ense C re dit , G eorg ia N atio na l G uard /A ir N atio na l G uard C re d it , C hil d a nd De pe ndent C are E xp ense C re d it ,
Georgia Form 500 In div id ual In co m e T a x R etu rn
Georgia Department of Revenue
20 12
5 P ag e
Y O UR S O CIA L S EC URIT Y N UM BER
2.
3.
5 .
C re dit s f r o m F orm I N D-C R ( R ura l P hys ic ia ns C re dit , D is a ble d P ers o n H om e P urc h ase o r R etr o fit C re d it , D riv e r E duca tio n C re dit , D is a ste r A ssis t-
1 .
4 . .00
.
00.
.
0 0
.00
00
6 . C OM PAN Y NAM E
7 .
8 . CO MPAN Y NAM E
9 . C OM PAN Y NA ME
1 0.
A ny a ddit io na l p ass -th ro ugh c re dit s c la im ed ( A tta ch s ch edu le )................ ......
.
OWNERSHIP
.
C RED IT C LA IM ED O N T H IS R ETU RN
COMP ANY NAME
OWNERSHIP
OWNERSHIP F
E IN
0 0
C RED IT C LA IM ED O N T H IS R ETU RN
F E IN
F E IN
F E IN
.0 0
C RED IT C LA IM ED O N T H IS R ETU RN
00
.00
C RED IT C LA IM ED O N T H IS R ETU RN
CREDIT CODE TYPE
CREDIT CODE TYPE
CREDIT CODE TYPE
CREDIT CODE TYPE
10 .
OWNERSHIP
.0 0
00.
00.
SC HED ULE 2 C RED ITS f or LIN E 1 7, P A GE 2 (s e e T a x B ookle t o n P ages 1 3 a nd 1 6)
3. Low Emission V ehicle Credit or Zero Emission V ehicle Credit .........
(R equ ir e s D NR c e rtif ic a tio n f o r e it h er c re dit )
V ers io n 1
In co m e e a rn ed in a n oth er s ta te a s a G eo rg ia r e s id en t is t a x a b le b ut o th er s ta te (s )
3. B USIN ESS I N CO M E O R ( L O SS)
8 . A DJU STE D G RO SS I N CO M E:
3
. B USIN ESS I N CO M E O R ( L O SS)
2
. I N TE R ESTS A ND D IV ID EN DS
8 . A DJU STE D G RO SS I N CO M E:
7 . T O TA L A DJU STM EN TS F R O M F O RM 5 00,
2
. I N TE R ESTS A ND D IV ID EN DS
)
A
N
M
U
L
O
C
( (COLUMN B)
3 . B USIN ESS I N CO M E O R ( L O SS)
1 . W AG ES, S A LA RIE S, T IP S, e tc
4 ,
D O N O T U SE L IN ES 9 T H RU 1 4 O F P A G E 2 , F O RM 5 00
8 . A DJU STE D G RO SS I N CO M E:
7 . T O TA L A DJU STM EN TS F R O M F O RM 5 00,
6 . T O TA L A DJU STM EN TS F R O M F O RM 1 040
2 . I N TE R ESTS A ND D IV ID EN DS
7 . T O TA L A DJU STM EN TS F R O M F O RM 5 00, 6
. T O TA L A DJU STM EN TS F R O M F O RM 1 04 0
6. T O TA L A DJU STM EN TS F R O M F O RM 1 04 0
5
. T O TA L I N CO M E: T O TA L L IN ES 1 T H RU 4
1
. W AG ES, S A LA RIE S, T IP S, e tc
S C HED ULE 1 , P A G E 4
4 . O TH ER I N CO M E O R (
L O SS)
L IN E 5 P LU S O R M IN US L IN ES 6 A ND 7
S C HED ULE 1 , P A G E 4
4 . O TH ER I N CO M E O R ( L O SS)
5 . T O TA L I N CO M E: T O TA L L IN ES 1 T H RU 4
L IN E 5 P LU S O R M IN US L IN ES 6 A ND 7
1
. W AG ES, S A LA RIE S, T IP S, e tc
4 . O TH ER I N CO M E O R ( L O SS)
FE D ER AL I N CO M E A FTE R G EO RG IA A DJU STM EN T
Georgia Form 500 In div id ual In co m e T a x R etu rn
Georgia Department of Revenue
20 12 Y O UR S O CIA L S EC URIT Y N UM BER
5 . T O TA L I N CO M E: T O TA L L IN ES 1 T H RU 4
S C HED ULE 1 , P A G E 4
L IN E 5 P LU S O R M IN US L IN ES 6 A ND 7
0 0. 00.
00. 00. 00.
00. 00. 00.
00. 00. 00.
00. 00. 00.
00. 00. 00.
00. 00. 00.
00. 00. 00
.00
6 P ag e
R ESID EN TS A ND N ONR ESID EN TS .
S C H ED U LE 3 C O M PU TA TIO N O F G EO RG IA T A XA B LE I N C O M E F O R O NLY P A RT-Y EA R
INCOME NOT TA XA BLE T O G EO RG IA GEORGIA INCOME
(COLUMN C)ta x c re d it m ay a p ply . S ee T a x B ookle t, P ag e 1 3 , L in e 1 7 a n d P ag e 1 5
1. 3.
2. 4.
9 . RAT IO : D iv id e L in e 8 , C olu m n C b y
12. T o tal Deductions and Exemptions:
1 1c.
1 1b. Number on Line 7a. multiplied by $3,000........................... ..................... 1 1b.
Add Lines 10 and 11c.............................
1 1a. Number on Line 6c. multiplied by $2,700........................... ......................
1 1. Personal Exemption from Form 500, Page 2 (See Tax Booklet, Pg. 17, Line 1 1a-c)
1 1 c. A dd L in es 1 1 a. a nd 1 1 b. E nte r t o ta l................................................................. ... ..
1 1 a.
1 2 .
1 3 .
E nte r h ere a n d o n L in e 1 5, P ag e 2 o f F orm 5 00 ... ... .. .. . ... .. . ... .. .. .. ... ... . ... .. . ... .. .. .. ..
L is t th e st ate (s ) in w hic h th e in co m e in C olu m n B w as e a rn ed a n d/o r to w hic h it w as re p orte d .
14. Georgia T axable Income: Subtract Line 13 from Line 8, Column C
14.
Lin e 8 , C olu m n A . E nte r p erc e nta ge............. 9.
.0 0
.00
.00
.00
.00
.00
.00
10. I te m iz e d o r S ta nda rd D edu ctio n ( S ee T a x B ookle t, P age 1 7, L in e 1 0).. 10 .
% Not to exceed 100%
1 3 . M ulti p ly L in e 12 b y R atio o n L in e 9 a nd e nte r r e su lt ...................... .....................
V ers io n 1
Part 2 - C hild an d D ep end en t C are E xp en se C re d it
O .C .G .A . § 48-7- 29.1 0 provi des t ax payers wi th a credit f o r qua lif ie d c hil d & dep enden t c ar e expe nses . T he c redit i s a per cen ta ge
o f t h e cre dit c lai med a n d allo wed un de r I n ter na l R even ue Co de § 2 1 a n d c lai med b y t h e t a xpa ye r o n t h e t a xp ay er’s F ed era l
i n co me t ax r e tu rn . Th e c re dit is c o m pu te d a s f ol lo w s:
1 . A mo un t o f c hi ld & depen de n t ca re e xpe nse
cre d it c lai med o n F ede ra l F orm 10 40 .
2 . G eo rg ia all ow ab le ra te ............................................................................... ...... .
3 . A llow ab le Ch il d & Depen de n t Ca re Ex pense Cre dit (L in e 1 x . 3 0 )
Ente r h e re a n d in clu d e in P art 1 0 .................................................................. .. ... ..
C IT Y (P le as e in se rt a spa ce if c it y h a s m ultip le n a m es) STA TE ZI P COD E
Part 1 - Disabled Person Home Purchase or Retrofit Credit
O. C.G.A.
§ 48-7-29.1 provides a disabled person credit equal to the lesser of $500 per residence or the taxp ayer ’s income t a x
liability for the purchase of a new single-family home that cont ains all of the accessibilit y features listed below. It also provides
a credit equ al to th e le sser o f th e co st or $12 5 to re tro fit an
exi stin g sing le-family home wi th on e or more o f thes e fea ture s. Th e
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.
In terio r pa ssag e doors pro vid in g a t lea st a 32-inc h-wide ope ning .
Rein forceme nts in ba throo m wal ls allowing ins talla tion o f grab bar s arou nd th e toi le t, tub, an d showe r, wh ere
such f a cilit ie s are provi ded .
Light switches and outlets placed in accessible locations.
T o qua lify fo r this c redi t, th e disa bled perso n mus t be perma nen tly di sab le d an d ha ve be en i ss ued a perm anen t p ar kin g perm it
by t h e Dep artment o f Re venu e or ha ve bee n is sued a s pe cia l perma nen t par kin g permi t by t h e Dep artment o f Re ven ue .
F or more in forma tion , s e e Reg ula tio n 560- 7-8- .4 4.
1. Purchase of a home that contains all four accessibility features OR total of accessibility
0
.
3
Georgia Form IND- CR (Re v. 9/12)
S ta te o f G eo rgi a In dividu al C redi t Fo rm
Georgia Departmen t of Revenue (Approved web version)
CHEC K I F ADDR ESS HA S CHAN GED
.
– Enclose with Form 500 – 20 12
2 . Ma xim um c re d it p e r res id e n ce ......................................................................................... ... .. . . .
3. E nt er the les ser of Line 1 or Line 2 and includ e in P art 10................................................... ..... ..
feat ures adde d to ret rofit a home (up to $125 per feat ure)..................................................... ..... ..
0 0
2 .
.00 1 .
.00 0 0
5
3 .
00.
%
1
.
2 .
3 .
00
SPOU SE’S SOCIA L SECU RITY NU MBER
DEPA R TM EN T USE O NLY )
r
e
b
m
u
N
g
n
i
d
l
i
u
B
r
o
e
t
i
u
S
,
t
p
A
r
o
f
e
n
i
l
s
s
e
r
d
d
a
d
n
2
e
s
U
(
)
X
O
B
.
O
.
P
r
o
T
E
E
R
T
S
D
N
A
R
E
B
M
U
N
(
S
S
E
R
D
D
A
SUFFIX
YOUR
FIRST NAME MI
L A ST NAM E YOU
R SOC IAL SECUR ITY NUM BER
V ersio n 1
1 P ag e
Part 4 - Qualified Caregiving Expense Credit
O. C.G.A.
§ 48-7-29.2 provides a qualified caregiving expense credit equal to 10 percent of the cost of qualified caregiving
expenses for a qualifying family member . The credit cannot exceed $150. Qualified services include Home health agency
s er vic es , per sona l c ar e ser vic e s, per sona l c are a ttend ant service s, home make r ser vice s, adu lt da y c are , re spi te care , or hea lt h
care equipmen t and other supplies which have been determined by a physician to be medically necessar y. Services must be
ob tained fro m an orga niza tion or indivi dual no t rela ted to th e t a xp a yer or th e qu alify ing family memb er.
The qualifying family member must be at least age 62 or been determined disabled by the Social Security Administration . A
qualifying family member includes the taxpayer or an individual who is related to the taxpayer by blood , marriage or adoption.
Q uali fie d c aregi vin g e xpens es do no t in clu de e xpen ses t hat
were sub trac te d t o arri ve a t G eorg ia ne t t a xabl e in come or f o r whi ch
amounts were excluded from Georgia net taxable income. There is no carryover or carry-back available. The credit cannot
exceed the taxp ayer ’s income t ax liabili ty . For more information, see Regulation 560-7-8-.43.
Q ual if y in g F amily Member Nam e:
Ag e, if 62 or o ver If d isab led, date o f disability
Name
:
Part
3 - Georgia National Guard/Air National Guard Credit
O.C.G .A.
§ 48-7- 29.9 provi des a t a x c redit fo r Georg ia re side nts who are memb ers o f th e Na tional Guar d or Ai r Na tional Gua rd
and are on a ctiv e du ty ful l tim e in th e Uni ted S ta te s Arme d For ces, or a ctiv e du ty trainin g in th e Un ited S ta tes Arme d For ce s f o r
a period of more than 90 consecutive days. The credit shall be claimed and allowed in the year
in which the majority of such
days are s erved . I n t h e e vent an equ al numb er o f c on se cu tiv e da ys are s er ve d in t w o c ale nda r y ear s, t he n t h e e xclu sio n shal l b e
claimed and allowed in the year in which the ninetieth day occurs. The credit shall appl y with respect to each taxable year in
which such member serves for such qualifying period of time. The credit cannot exceed the amount expended for qualified life
insurance premiums nor the taxp ayer ’s income tax liabili ty . Q ual if ie d lif e ins ura nce premiu ms a re th e premiu ms pa id fo r
in suranc e c o vera ge t hrou gh t h e s er vic e memb er’s G rou p Li fe I n suran ce P rogr am admi nis tere d by t h e Uni ted S ta te s De par tme nt
o f V etera ns A ff air s. A ny un use d t a x c red it is allo wed t o b e
c arri ed f orwa rd t o t h e t a xp a ye r’s s u cc eedi ng y e a r’s t a x liab il i t y .
1. Enter amount of qualified life insurance premium s and include in Part 10.. 1.
0 0.
SS # Rela tionsh ip
2 P ag e
Georgia Form IND- CR
Sta te o f G eo rgi a In div idu al C redi t Fo rm
Georgia Departmen t of Revenue
20 12 YOU R SOC IAL SECUR ITY NUM BER
3.
1
1 . Q ua li f ie d c areg ivin g e xpe nses...................................................................... ... ..
2 . P erc en ta g e li m it a tio n.................................................................................. .....
3 . L in e 1 m ultipl ie d b y L in e 2 ........................................................................... ... ..
4 . Ma xim um c re dit............................................................................................. ..
5. Enter the lesser of Line 3 or Line 4 and include in Part 10....................................
0 %
00
0 0
.
.
.00
00. 5 0
1
2 .
1
.
4 .
5 .
V ersio n 1
2. Amount of the disast er as sis tance received ............................................ ... ..
3 . Maxi mum c re dit................................................................................... .. .. .
4. Enter the lesser of Line 2 or Line 3 and include in Part 10.............................
1
. D ate o f S ucce ss fu l Comp le tio n ............................................................. ..
2. Amount paid for the successfull y completed course..................................
3 . Ma xim um c re dit.................................................................................... .
4. Enter the lesser of Line 2 or Line 3 and include in Part 10..........\
................ B
irth Da te
0 0 4 .
00.
00.
Name o f pri va te dri ve r t rainin g s c ho ol
Name o f depen den t mino r c hil d
1.
2 .
3 .
S
S#
5 0
1
.
Georgia Form IND- CR
Sta te o f G eo rgi a In dividu al C redi t Fo rm
Georgia Departmen t of Revenue
20 12
Part 5- Driver Education Credit
O.C.G .A. § 48-7- 29.5 pro vides f o r a dri ve r edu ca tio n c redi t. T hi s i s a c redit f o r an amou nt p aid f o r a depen den t mino r c hil d f o r a
successfull y completed course of driver education at a private driver training school licensed by the Departmen t of Driver
S er vic e s und er Cha pte r 13 o f T it le 43 , “ T he Dri ver T raining S choo l Li cen se A ct.” T he amou nt o f t h e c redit is equal t o $15 0 or h e
a ctua l amount p aid , whi ch eve r is le ss. A priva te driver t rainin g s cho ol is one t hat primar ily eng age s in o ff eri ng drivi ng ins tru ctio n.
This does not includ e schools owned or operated by local, state, or federal governments. An amount paid for a
completed course of
driver education to a private or public high school does not qualify for this credit. A completed
c our se o f dri ver educa tio n in clude s add it iona l c our ses o ffere d by priva te drive r t rai ning schoo ls such as de fensiv e dri ve r ed uca tio n.
This tax credit is only allowed once for each dependen t minor child of a taxp ayer . The amount of the tax credit cannot exceed
the taxp ayer ’s income t ax liabili ty . The credit is not allowed with respect to any driver education expenses either deducted or
subtracted by the taxpayer to arrive at Georgia taxable net income or with respect to any driver education expense s for which
amou nts were e xclud ed fro m Georgia ne t ta xab le inco me. Any unus ed t ax cred it cann ot be carri ed forw ard to an y suc ceed ing
years’ t ax liability and cannot be carried back to any prior years’ t ax liabili ty . V isit
ww w .dd s.ga .gov /T ra ining /inde x.a sp x.
P ar t 6 - D isast er Ass ista nce Cre dit
O. C.G.A.
§ 48-7-29.4 provide s for a credit for a taxp ayer who receives disaster assistance during a taxable year from the
Georgi a Emerge ncy Manage ment Agen cy or th e Fed eral Emerge ncy Manage ment Agen cy. Th e amount o f th e cred it is equ al
t o $50 0 or t h e ac tua l amou nt o f t h e di sa ste r as sis tan ce , which ever is les s. T he credi t cann ot e xceed t h e t a xp ayer’ s incom e t a x
liabili ty . Any unused tax credit can be carried forward to the succeeding years’ tax liabilit y but cannot be carried back to the
prior years’ t ax liabili ty . The approval letter from the disaster assistance agency must be enclosed with the return.
Th e follo wing type s o f as sis tan ce qua lify :
Gran ts f ro m t h e Dep artment o f Huma n S er vic e s’ I ndi vidu al and F amil y G rant P rogra m.
Gran ts fro m GEM A and /or FEM A.
Loans from the Small Busines s Administration that are due to disasters declared by the Presiden t or Governor .
Disaster assistance agency
1 . D ate a ss ist an ce w as rece iv e d ............................................................... ... ..
1 .
2 .
3 .
.00
.00 0 0
5
4 . .00
3 P ag e
YOU R SOC IAL SECUR ITY NUM BER
00
V ersio n 1
Part 8- Adoption of a Foster Child Credit
1 . Georg ia Cod e Se ctio n 48-7- 29.1 5 provi des an in come tax credit fo r th e ad optio n o f a qu alifie d fo ste r chi ld . Th e amou nt o f
the credit is $2,000 per qualified foster child per taxable year , commencing with the year in which the adoption becomes
final, and ending in the year in which the adopted child attains the age of 18. This credit applies to adoption s occuring in
the taxable years beginning on or after January 1, 2008.
1
.The physician must have started working in a rural county after July 1, 1995. If the physician worked in a rural county prior
to that date, a period of at least three years must have elapsed before the physician returns to work in a rural county .
2 .The physician must practice and reside in a rural county . For taxable years beginning on or after January 1, 2003, a
physician qualifie s for the credit if they practice in a rural county and
reside in a county contiguou s to a rural county . A
rura l coun ty i s de fine d a s one wi th 65 or fewe r per son s per squ are mile a ccord ing to th e Uni ted S ta te s De cennial C ens us o f
1990 or any future such census. For taxable years beginning on or after Januar y 1, 2012, the United States Decennial
Census of 2010 is used (see regulation 560-7-8-.20 for tr ansition rules). A listing of rural counties for purposes of the
3 .The physician must be licensed to practice medicine in Georgia, primarily admit patients to a rural hospital , and practice in
the fields of family practice, obstetrics and gynecolog y, pediatrics , internal medicine , or general surgery . A rural hospi tal is
defined as an acute-care hospital located in a rural county that contain s 80 or fewer beds. For taxable years beginning on
or after Januar y 1, 2003, a rural hospital is defined as an acute-care hospital located in a rural county that contain s 100
or f ewe r beds .
1 . C ou n ty o f re sid en ce ........................................................ ..
2 . C ou n ty o f p ra ctic e .......................................................... ..
3 . T yp e
o f p ra ctic e ......................................................... .......
4. Date started working as a rural physician ...........................
5. Number of hospital beds in the rural hospital.......................
Part
7- Rural Physicians Credit
O. C.G.A.
§ 48-7-29 provides for a $5,000 t ax credit for rural physicians. The tax credit may be claimed for not more than five
years. There is no carryover or carry-back available. The credit cannot exceed the taxp ayer ’s income tax liabili ty . In order to
quali fy , the physician must meet the following conditions:
For more information, see Regulation 560-7-8-.20.
6. Rural physicians credit, enter $5,000 and include in Part 10. 3
.
2
.
1
.
4 .
5 .
6 . .00
.
1
.
.
.
0
1
t
r
a
P
n
i
e
d
u
l
c
n
i
d
n
a
d
l
i
h
c
r
e
t
s
o
f
d
e
i
f
i
l
a
u
q
r
e
p
0
0
0
,
2
$
r
e
t
n
E
P ag e 4
Georgia Form IND- CR
Sta te o f G eo rgi a In div idu al C redi t Fo rm
Georgia Departmen t of Revenue
20 12
YOU R SOC IAL SECUR ITY NUM BER
.00
rural physicians credit may be obtained at the following w eb page:
etax.dor.ga.gov/inctax/proposed_regs/ruralphysiciancount ies.aspx
V ersio n 1
A taxpayer is allowed the tax credit for a purchase of one eligible single-family residence made between June 1, 2009 and
No vembe r 30 , 200 9. Th e credit amou nt i s th e le sse r o f 1 .2 per cent o f th e pur chase pri ce of th e eligible sing le-famil y re sidenc e
or $1,800.00 . The amount of the tax credit that may be claimed and allowed in a single tax year cannot exceed the lesser of
1/3 of the credit or the taxp ayer ’s income t ax liabili ty . Any unused tax credit can be carried forward but cannot be carried back.
Pag e 5
Part 9- Eligible Single-Family Residence Tax Credit
O.C.G .A . § 48-7- 29.1 7 provide s t ax pa yers a c redi t fo r th e pur cha se o f an el igible sin gle- famil y re sid ence lo ca ted in Georg ia . An
eligible single-family residence is a single-family structure (including a condominium unit as defined in O.C.G .A.§ 44-3-71) th at
i s o cc up ie d f o r r es iden tia l pur po se s b y a s in gle f am il y , t h a t is :
a ) A ny r e sid en ce (i nc lud in g a n e w re siden ce , o n e o cc up ie d a t t h e t im e o f s al e, o r a pr ev ious ly o cc up ie d r e siden ce ) t h a t w as
f o r s a le pr io r t o M ay 1 1 , 2 0 0 9 a n d t h a t rema in e d f o r s a le a ft e r M ay 1 1 , 20 09 ; o r
b) A re sid en ce w it h re spe ct t o whi ch a f ore clo sur e e vent has t a ke n pla ce and wh ic h i s owned b y t h e mor tgago r or t h e mor tgago r’s
age nt;o r
c) A n owner-occupie d residen ce wit h respect t o which t he owne r’s acqui sition indeb tednes s was in def ault on or bef ore Marc h
1 , 20 09 . Ac quisit io n ind eb tedn ess i s de bt in cur re d i n ac quiri ng , c o n st ruc tin g, o r s u b sta n tia ll y improv in g a qua li f ie d r e sid en ce
a n d wh ic h is s e cur ed b y s u ch res iden ce . R efin an ce d de bt is ac qui sit io n de bt if a t le ast a po rtio n o f s u ch de bt r e finan ce
s t h e
pr in cip al amo un t o f ex is tin g a cqu isit io n ind eb ted ne ss .
The taxp ayer must have claimed the credit in 2009 in order to claim the unused credit below.
Georgia
Form
IND- CR
Sta te o f G eo rgi a In dividu al C redi t Fo rm
Georgia Departmen t of Revenue
20 12 V ersio n 1
YOU R SOC IAL SECUR ITY NUM BER
1. . 1. T otal credi t. (E nter amou nt fro m 2009 IND-CR , P art 9, Lin e 5. )...............................
2 . M ax im um allo w ed p e r y e a r............................................................................. ... .. .
3. Maximum credit allowed, (multiply Line 1 by Line 2)........... .....................................
3.
2
. 00
0 0
.
.3 3 % 33
Part 10- T otal Section
1 . Add Part 1, Line 3; Part 2, Line 3; Part 3, Line1 ; Part 4, Line 5; Part 5, Line 4;
Part 6, Line 4; Part 7, Line 6; Part 8, Line 1; and Part 9, Line 5.
Enter the total here and on Form 500, Page 5, Schedule 2 , Line 2. ....................... 1.
00.
4. Enter unused credit (Total credit less amounts used in 2009, 2010, and 2011).......
5. Credit allowed, smaller of line 3 or line 4, enter here and i nclude in Part 10............ 4
. 00.
5 . 00.
If you want to remove Georgia Individual Income Tax Return Form from this website please contact us providing the reasons together with this url: https://formsarchive.com/georgia-individual-income-tax-return-form/