Form G-1000 - Transmitter Report And Summary Of Magnetic Media - Georgia Department Of Revenue

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W-2c for W-2
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Form G-1000
DEPARTMENT OF REVENUE
TRANSMITTER REPORT AND
SUMMARY OF MAGNETIC MEDIA
1. NUMBER OF REPORTING MEDIA IN THIS FILE
2. TYPE OF DATA BEING REPORTED (check only one)
Magnetic Tape(s)
W-2
[
]
Diskette(s)
[
]
Cartridge(s)
3. NAME AND ADDRESS OF PERSON TO CONTACT ABOUT THIS MAGNETIC MEDIA FILE
(include street, city and ZIP code)
4. Telephone Number (area code)
5. TOTAL AMOUNT OF FORM W-2 FIELDS
State ID number
FEI number
Number of W-2 Forms
Wages, tips, other compensation
State income tax withheld
INSTRUCTIONS FOR MAGNETIC MEDIA REPORTING
this form in
and submit it with your magnetic tape, diskette or cartridge.
Please complete
its entirety
Mail To:
Georgia Department of Revenue
Withholding Tax Section
P. 0. Box 38427
Atlanta, Georgia 30334
ITEM 1
Indicate number of tapes, cartridges or diskettes covered by this transmittal.
ITEM 2
Indicate whether this file contains original or corrected data.
ITEM 3 & 4
Enter name, address and telephone number of person to contact concerning magnetic
media file.
Enter the totals for all W-2’ s, wages, tips, etc., and state withholding covered in this file.
ITEM 5
These forms may be photocopied or computer generated, provided the affidavit and signature are in-
cluded on the form.
AFFIDAVIT
Under penalties of perjury, I declare that I have examined this return, including accompanying docu-
ments, and to the best of my knowledge and belief it is true, correct and complete.
DATE
TITLE
SIGNATURE
7

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