Form 501 X Amended Georgia Fiduciary Income Tax Return
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1
2Form 501 X
Department
Use Only
Department of Revenue
Income Tax Division
(Rev. 11/03)
Change of
Address
Tax Year ____________
Amended Georgia Fiduciary Income Tax Return
Please answer all questions, fill in all applicable items, and explain changes on page 2.
A. Federal Employer Id. No.
Name of Estate or Trust
B. Date of Creation of Trust or
Name and Title of Fiduciary
Telephone No.
Decedent’s Death
Address of Fiduciary (Number and Street)
City, State, and Zip Code
C. Name and address on last year’s return if different from above. If no return was filed last year, state reason.
WAS A FEDERAL AMENDED RETURN FILED? [ ] YES [ ] NO - IF YES, PLEASE ATTACH COPY.
A
B
C
As originally
Net Change
Correct
Calendar Year 20________ or Fiscal Year Ending ____________
reported or as
Increase or
Amount
adjusted
Decrease
1. Income of fiduciary
(Gross income less itemized deductions from attached Form 1041)
2. Adjustments: (List all items in Schedule 1, Page 2)
3. Total (Line 1 plus or minus Line 2)
4. Beneficiaries’ shares of income (Total of Schedule 2)
5. Balance (Line 3 less Line 4)
6. Exemptions: (See instructions for amounts based on tax year)
7. Net taxable income of fiduciary (Line 5 less Line 6)
8. Total Tax
PAYMENTS AND CREDITS
9. Other Credits
10. Estimated Tax Payments: Georgia Form 501
11. Amount paid with original return, plus additional payments made after it was filed
12. Total of Lines 9 through 11, Column C
REFUND OR BALANCE DUE
13. Overpayment, if any, shown on original return: Georgia Form 501
14. Subtract Line 13 from Line 12 and enter result
15. If Line 8, Column C is more than Line 14, enter Balance Due
16. Add interest (at 12%)
17. Total of Lines 15 and 16. Pay in full with this Return
18. If Line 8, Column C is less than Line 14, enter refund to be received
Under penalties of perjury, I declare that I have filed an original return and that I have examined this amended return, including accompanying schedules and statements, and
to the best of my knowledge and belief this amended return is true, correct, and complete.
Sign Here
_____________________________________________________
_____________________________________________________________
Signature of Fiduciary
Date
Signature and identification number of preparer other than taxpayer, based on
all information of which s/he has any knowledge.
MAIL COMPLETED RETURN TO: GEORGIA INCOME TAX DIVISION 1200 TRADEPORT BLVD. ROOM 1056 ATLANTA, GA 30354
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.
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