Telefile Tax Record And Instructions - Georgia Department Of Revenue - 2000 Page 5

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Keep This Document For Your Tax Records. Do Not Mail!
500-T
GEORGIA INDIVIDUAL INCOME
2000
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 page 4.)
Expecting a
Checking
Savings
Type of Account:
refund?
Use Direct
Deposit
Routing Transit Number
Depositor Account Number
A .
TeleFile will ask for the amount of state tax withheld (Box 18 on Form W-2) and the
Make sure you have all your W-2s.
Employer's state ID number (Box 16 on Form W-2) for each W-2.
ä TeleFile will tell you the following amounts during the call. Please write them in the spaces below
.
Georgia Adjusted Gross Income (This is the same as your
B.
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 (only if you have an overpayment)
You may
1.
Georgia Wildlife Conservation Fund.............................................................
contribute
all or a
2. Children and Elderly Fund............................................................................
portion of
your refund
3. Georgia Cancer Research Fund ......................................................................................
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.
Confirmation
Wait for the
Date of Call
Number
/
/ 2001
Confirmation
Number before you
Keep This Document For Your Tax Records. Do Not Mail!
hang up. Write it
down here.
-5-

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