Telefile Tax Record And Instructions - Income Tax Return - Georgia Department Of Revenue - 2001 Page 5

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Keep This Document For Your Tax Records. Do Not Mail!
500-T
2001
GEORGIA INDIVIDUAL INCOME
State of Georgia
TELEFILE TAX RECORD
Department of Revenue
You must complete the top
portion of the Federal
TeleFile record and Line A
of this tax record
BEFORE calling the number
on your Federal TeleFile
Tax Record.
Direct Deposit Information (Optional- See instructions on page 4)
Expecting a
Type of Account:
Checking
Savings
refund?
Use Direct
Deposit
Routing Transit Number
Depositor Account Number
A.
Make sure you have all your W-2s.
TeleFile will ask for the amount of state tax withheld (Box 18 on Form W-
2) and the Employer's state ID number (Box 16 on Form W-2) for each W-2.
.
TeleFile will tell you the following amounts during the call. Please write them in the spaces below
B. Georgia Adjusted Gross Income (This is the same as
your federal adjusted gross income.).................................
During the
call, enter
C. Taxable Income ................................................................
the amounts
reported
D. Income Tax Liability (STATE TAX) ..................................
by TeleFile
E. Overpayment ....................................................................
F. Contributions
1. Georgia Wildlife Conservation Fund....................
You may
contribute
all or a
2. Children and Elderly Fund.....................................
portion of
your refund
3. Georgia Cancer Research Fund..........................
(See page 3)
Do not
G. Amount of Your Refund ................................................
mail this
Tax Record
H. Amount You Owe ...........................................................
Important: You will be required to make the following declaration:
Under penalties of perjury, I declare that to the best of my knowledge and belief, the return information I
provided is true and correct, and includes all amounts and sources of income I received during the tax year.
Wait for the
Confirmation
Date of
Confirmation
/
/
Number
Call
Number before
you hang up.
Write it down
Keep This Document For Your Tax Records. Do Not Mail!
here.
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