Form G-1003 - Income Statement Return - 2016
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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.
2. Complete the worksheet below to automatically create your return.
3. Click the “Print” button to print a completed G-1003 return.
4. Sign and date the return.
5. Cut the return along the dotted line. Mail only the return to the address on the return. Do not
send a payment with this return, submit an amended G-7 if additional tax is due.
DO NOT fold, staple or paper clip items being mailed.
DO NOT mail in the worksheet, keep this for your records.
G-1003 Worksheet
1. GA Withholding ID:
2. FEI Number:
4. Domestic Employers:
3. Amended Return:
5. Name: .............................
6. Street Address Line 1:
7. Street Address Line 2:
8. City:
9. State:
10. Zip:
-
0000
Telephone:
Check here if correction to SSN only
11.
W-2:
W2-C:
1099 Misc Non-employee Compensation(NEC):
12. Form Type:
1099 Other Income:
G2-A:
13. Tax Year/Fiscal Year Ending: ..................................................
Select
Number Of Forms: ....................................................................
14.
15.
Georgia Taxable Wages: ..........................................................
Georgia Tax Withheld : ...........................................................
16.
Clear
Print
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Parent category: Financial