Georgia Form 500 - Individual Income Tax Return - 2006 Page 3

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500
Georgia Form
Individual Income Tax Return
Georgia Department of Revenue
2006
Your Social Security Number
SCHEDULE 1 ADJUSTMENTS to INCOME BASED on GEORGIA LAW (see Tax Booklet on Pages 7 and 8)
ADDITIONS to INCOME
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1. Interest on Non-Georgia Municipal and State Bonds ...............................................
1.
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2. Lump Sum Distributions ............................................................................................
2.
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3. Federal deduction for income attributable to domestic production activities
3.
(IRC Section 199)
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4. Other (specify)
4.
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5. Total Additions (enter sum of Lines 1-4 here) ..........................................................
5.
SUBTRACTION from INCOME
6. Retirement Income Exclusion (see Tax Booklet on Page 12)
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6
. a
Date of Disability:
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Date of Disability:
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7. Social Security Benefits (Taxable portion from Federal return) ................................
7.
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8. Georgia Higher Education Savings Plan ..................................................................
8.
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9. Interest on United States Obligations (See Tax Booklet on Page 7) ........................
9.
10. Other Adjustments (specify)
Adjustment
__________________________________
Amount _______________
Adjustment
__________________________________
Amount _______________
Adjustment
__________________________________
Amount _______________
Adjustment
__________________________________
Amount _______________
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Total ......................
10.
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11. Total Subtractions
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11.
(enter sum of Lines 6-10 here)
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12. Net Adjustments
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12.
(Line 5 less Line 11. Enter Net Total here and on Line 9 of Page 1)(+ or -)
SCHEDULE 2 CREDITS for LINE 17, PAGE 2
(see Tax Booklet on Page 8)
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1. Other State(s) Tax Credit
1.
(see Tax Booklet on Page 11) .........................................................
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2. Low and Zero Emission Vehicle Credit .....................................................................
2.
3. Credits from Form IND-CR (
Rural Physicians Credit, Disabled Person Home Purchase or
Retrofit Credit, Driver Education Credit, Disaster Assistance Credit, Qualified Caregiving Expense Credit,
Georgia National Guard/Air National Guard Credit, Child and Dependent Care Expense Credit
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3.
and Conservation
Credit) ...............................................................................................................
Pass Through Credits from Ownership of Sole Proprietor, S Corp., LLC or Partnership Interest
You must list the appropriate Credit Type Code in the space provided. List the percentage of credit received in the % column. If you claim more than two
credits, enclose a schedule. Enter the schedule total on Line 6 . See Tax Booklet on Page 24 for a list of available credits and their applicable codes.
Credit Type
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C
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Code
Name
on this Return
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. 4
. 4
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. 5
. 5
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6. Enter the total from enclosed schedule(s) ...................................
6.
Available Unused Credit
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7. Enter the total of Lines 1 thru 6 here and on Line 17, Page 2.
7.
Page 3

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