Georgia Form 500 Draft - Individual Income Tax Return
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7Please print your numbers like this in black or blue ink:
500
Georgia Form
(Rev. 7/07)
Please check box if you
Individual Income Tax Return
DO NOT want a booklet next year
Georgia Department of Revenue
2007
DEL
EXT
(Approved booklet version)
FISCAL YEAR BEGINNING
FISCAL YEAR ENDING
YOUR SOCIAL SECURITY NUMBER
YOUR FIRST NAME
MI
1.
LAST NAME
SUFFIX
SPOUSE’S SOCIAL SECURITY NUMBER
2.
SPOUSE’S FIRST NAME
MI
LAST NAME
SUFFIX
DEPARTMENT USE ONLY
ADDRESS (NUMBER AND STREET or P.O. BOX)
CHECK IF ADDRESS HAS CHANGED
APT., STE., or BLDG.
CITY
STATE
ZIP CODE
3.
COUNTRY IF FOREIGN
Residency Status
4. Enter your Residency Status with the appropriate number......................................................................................................
4.
1.
Full-Year Resident 2. Part-Year Resident from
to
3. Nonresident
Filing Status
Part-Year Residents and Nonresidents must omit Lines 9 thru 14 and use Schedule 3 of Form 500, page 4
5. Enter Filing Status with appropriate letter (Must be the same status used on your Federal Return) .................................................
5.
A. Single
C. Married filing separate (Spouse’s social security number must be entered above)
B. Married filing joint
D. Head of Household or Qualifying Widow(er)
6. Number of exemptions (Check appropriate box(es) and enter total in 6c.)
6a. Yourself
6b. Spouse
6c.
nts (If you have more than 3 dependents, attach a list of additional dependents)
Depende
FIRST NAME, MIDDLE INITIAL
LAST NAME
DEPENDANT’S SSN
RELATIONSHIP TO YOU
7. Number of Dependents (DO NOT include yourself or your spouse) .. ...................................................................................
7a.
Add Lines 6c and 7a. Enter total............................................................................................................................................
7b.
Page 1
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