Form 500-Es - Individual And Fiduciary Estimated Tax - 2012
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1
2State of Georgia Department of Revenue
KEEP THESE INSTRUCTIONS AND WORKSHEET WITH YOUR RECORDS
Instructions
1. Download (free) the latest version of Adobe Reader X.
2. Complete the worksheet below to automatically create your payment voucher.
3. Click the “Print” button to print a completed 500 ES Individual/Fiduciary payment voucher.
4. Cut the payment voucher along the dotted line and mail the voucher and your payment only to
the address on the voucher
DO NOT fold, staple or paper clip items being mailed.
DO NOT mail in the worksheet, keep this for your records
500-ES Worksheet for Individual/Fiduciary
1. Taxpayer’s SSN or FEIN:
2. Spouse’s SSN :
3. Individual or Fiduciary Name:
4. Street Address Line 1 :
5. Street Address Line 2 :
6. City :
7. State:
8. Zip:
-
9. Please Select Tax Type of Return: .........................
Select
10. Check If Address Change : .....................................
11. Calendar Year or Fiscal Year Ending :
Select
12. Due Date : .................................................................
Select
13. Amount Paid : ..........................................................
Print
Clear
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Parent category: Financial