Form G-1003 - Income Statement Transmittal Form 2001
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1G-1003
MAIL TO:
(rev.9/01)
Georgia Department of Revenue
Withholding Tax Section
Georgia Department of Revenue
P.O. Box 98077
DO NOT SUBMIT PAYMENT WITH THIS FORM
Atlanta, GA 30359
(404)417-3210
INCOME STATEMENT TRANSMITTAL FORM
GA Withholding Number
FEIN
Tax Year
Number of Forms
Department Use Only
Employer Name and Address
Form Type:
Georgia Taxable Wages
( ) W-2
( ) G-2A
( ) 1099 ( ) Other_____
Media Type:
Georgia Tax Wihheld
( ) Paper
( ) Diskette
( ) Cartridge
I declare under the penalty of perjury that this return has been examined by me and to the best of my knowledge is a
true and complete return.
Signature
Title
Telephone
Date
Requirements for filing Wage and Information Statements
n
Employers reporting 250 or more income statements must submit them on magnetic media. Employers with less
than 250 statements may report magnetic media or paper copy. To obtain a copy of DOR specifications, call
404-417-3210 or visit our website:
n
Magnetic media and paper copy reports are due on or before the end of February of the following calendar year. If this
date is a weekend or holiday, the due date is the next business day.
n
Income statements are due within 30 days after payment of final wages if a business closes during the taxable year.
n
Submit non-wage statements (1099) only if Georgia withholding is indicated. Statements that do not indicate Georgia
withholding may be filed under the combined Federal/State Filing Program.
n
File Form G-1003 and magnetic media or paper copy income statements to:
Georgia Department of Revenue
Withholding Tax Section
P.O. Box 98077
Atlanta, GA 30359
Instructions for completing the Transmittal Form G-1003
DO NOT SEND PAYMENT WITH THIS FORM. SUBMIT AN AMENDED G-7 RETURN IF ADDITIONAL TAX IS DUE
Number of Forms- enter the number of forms submitted by each employer.
Form Type- enter the type of forms submitted by each employer (i.e. W-2, 1099R, 1099-Misc,....)
Media Type- indicate the method of submitting returns in the appropriate area.
GA Taxable Wages- enter wages taxable to Georgia only.
GA Tax Withheld- enter tax withheld and paid to Georgia only.
MAIL TO:
Georgia Department of Revenue
Withholding Tax Section
P.O. Box 98077
Do Not Cut This Page
Atlanta, GA 30359
Send in the entire sheet.
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