Form 500 - Individual Income Tax Return - 2002
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4GEORGIA FORM 500
INDIVIDUAL INCOME TAX RETURN
2002
Page 1
DEPARTMENT USE ONLY
Fiscal Year Mo.
Day
Year
Mo.
Day
Year
DEL.
EXT.
MISC.
Beginning:
Ending:
YOUR FIRST NAME
INITIAL
YOUR SOCIAL SECURITY NUMBER
Mark box with an X if you
do not want a tax booklet
next year.
YOUR LAST NAME
SUFFIX
MUST ENTER SS #
SPOUSE’S FIRST NAME
INITIAL
SPOUSE’S SOCIAL SECURITY NUMBER
SPOUSE’S LAST NAME
SUFFIX
CHECK IF
ADDRESS CHANGE
ADDRESS LINE 1
USE BLACK INK
ADDRESS LINE 2
ONLY
CITY
STATE
ZIP CODE
COUNTRY IF FOREIGN
4. Use one option only and enter in the Residency Code Number box.
RESIDENCY
PART-YEAR RESIDENTS AND NONRESIDENTS MUST OMIT LINES 9 THROUGH 14 AND USE SCHEDULE 3 OF FORM 500, PAGE 4
CODE NUMBER
1. FULL-YEAR RESIDENT 2. PART-YEAR RESIDENT FROM
TO
3. NONRESIDENT
5. Fill in Filing Status Block with appropriate letter.
(Must be same status as used on your Federal Return)
FILING
STATUS
A. SINGLE
C. MARRIED FILING SEPARATE (Spouse’s social security no. must be entered above)
B.
MARRIED FILING JOINT
D. HEAD OF HOUSEHOLD OR QUALIFYING WIDOW(ER)
6. Dependents:
DEPENDENT’S
DEPENDENT’S
FIRST NAME
LAST NAME
SOCIAL SECURITY NUMBER
RELATIONSHIP TO YOU
If more than 4
dependents,
enclose a list.
7. Total Number of Exemptions from Federal Form 1040 or 1040A (see instructions) ............................................... 7.
IF AMOUNT ON LINE 8, 9, 10, 13, OR 15 IS NEGATIVE, FILL IN CIRCLE. EXAMPLE:
If the amount on Line 8 is $40,000 or more or your adjusted gross income is less than your W-2s, you must enclose a copy of your Federal Form 1040 Pages
1 and 2. Regardles of income, if you use itemized deductions, you must enclose Federal Schedule A. Do not enclose other Federal Schedules.
8.
Federal adjusted gross income (From Federal Form 1040 or 1040A or 1040EZ )
,
,
.
8.
DO NOT USE FEDERAL TAXABLE INCOME
......................................................................
,
,
.
9. Adjustments from Schedule 1.
9.
(See instructions on Page 6, Line 9) ..............................
,
,
.
10. Georgia adjusted gross income
10.
(Net total of Line 8 and Line 9) ....................................
,
11.
11a.
Use EITHER
STANDARD Deduction
(SEE INSTRUCTIONS-LINE 11) DO NOT USE FEDERAL STANDARD DEDUCTION ...
Line 11c or Line12
,
(DO NOT WRITE ON BOTH)
11b.
b. Self 65 or over?
blind?
SPOUSE 65 or over?
blind?
Total of boxes
x 1,300=
.
,
0 0
11c.
c. TOTAL STANDARD Deduction (Line 11a + Line 11b) .........................................................................................
12.TOTAL ITEMIZED Deductions used in computing Federal taxable income
,
,
.
12.
Schedule A-Form 1040
Less: See Line 12 instructions
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