Form It-550 - Claim For Refund Of Georgia Income Tax Erroneously Or Illegally Collected - 2007

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IT-550 (Rev. 12/07)
CLAIM FOR REFUND OF GEORGIA INCOME TAX
STATE OF GEORGIA
ERRONEOUSLY OR ILLEGALLY COLLECTED
DEPARTMENT OF REVENUE
TAXPAYER SERVICES DIVISION
Name
IMPORTANT
SEE INSTRUCTIONS ON
Street and Number
BACK PAGE FOR USES
OF THIS FORM AND
City or Town
County
State
Zip Code
FOR MAILING
ADDRESSES
Federal Employer ID Number
Georgia Withholding Number
Taxpayer’s Social Security Number
Spouse’s Social Security Number
Tax Type:
Withholding
Corporate
Individual
1. Taxable year or period for which taxes were paid:
Calendar year or period
or fiscal year ending
,
2. Amount of tax paid
$
3. Amount of tax due
$
4. Amount of refund claimed
$
Claimant believes that this claim should be allowed for the following reasons:
(Attach separate pages if additional space is needed.)
I (we) declare under the penalties of perjury that this claim (including any accompanying schedules and statements) has been examined by
me (us) and to the best of my (our) knowledge and belief is true and correct.
Date__________________ , ___________
Signed: __________________________________________
(Claim must be signed by both husband and wife if
__________________________________________
a joint return was filed. Corporate officer should state his/her title. )
__________________________________________________________________________________________________________
THIS SECTION IS FOR OFFICIAL USE ONLY.
I recommend that action on this claim be taken as indicated in the following schedule.
Amount Claimed
$____________________
Amount Rejected
$____________________
Amount Allowed
$____________________
Interest From_____________To_____________
$____________________
Total
$____________________
Examined by:
Approved by:
Based on the facts as stated in this claim and on the certificate of the Examining and Approving Agents, it is directed that the
refund be issued or denied as indicated above.
Date___________________________ , ________ By
Georgia Department of Revenue, Taxpayer Services Division

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