Georgia Form It-553 - Application For Tentative Carry-Back Adjustment For Use By Taxpayers Other Than Corporations

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IT-553
Georgia Form
)
Mailing Address
(Rev. 3/05
Tentative Carry-Back Adjustment
Georgia Department of Revenue
For Other Than Corporations
Processing Center
P.O. Box 740320
Atlanta, Georgia 30374-0320
STATE OF GEORGIA
APPLICATION FOR TENTATIVE CARRY-BACK ADJUSTMENT FOR USE BY TAXPAYERS OTHER THAN CORPORATIONS
NAME
YOUR SOCIAL SECURITY #
NUMBER, STREET, AND APT. OR SUITE NUMBER
SPOUSE’S SOCIAL SECURITY #
CITY
COUNTY
STATE
ZIP CODE
FEDERAL EMPLOYER I.D. NUMBER (IF ANY)
_________________
_______________
NET OPERATING LOSS: $
TAXABLE YEAR OF NET OPERATING LOSS: CALENDAR YEAR
; OR
_______________
_______________
OTHER YEAR BEGINNING
AND ENDING
PLEASE ATTACH A COPY OF YOUR FEDERAL APPLICATION FOR N.O.L. ADJUSTMENT
PART YEAR AND NONRESIDENTS, SEE INSTRUCTIONS ON PAGE 3
___________________ PRECEDING TAX
___________________ PRECEDING TAX
___________________ PRECEDING TAX
TAX YEAR:
YEAR ENDED ______________________
YEAR ENDED ______________________
YEAR ENDED ______________________
(a) Return as filed or
(b) Liability after
(c) Return as filed or
(d) Liability after
(e) Return as filed or
(f) Liability after
application of
liability as last
application of
liability as last
application of
liability as last
Computation of overpayments
determined
carry-back
determined
carry-back
determined
carry-back
1. Federal adjusted gross income
See Page 4 of the instructions
2. Georgia adjustments.
See Page 4 of the instructions
3. Georgia adjusted gross income
Net total of Lines 1 and 2.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
4. Net operating loss.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
5. Subtract Line 4 from Line 3
6. Deductions.
See Page 4 of the instructions
7. Subtract Line 6 from Line 5.
8. Exemptions.
See Page 4 of the instructions.
9. Taxable income.
Subtract Line 8 from Line 7.
10. Income Tax.
11. Credits.
See Page 4 of the instructions.
12. Tax after credits.
Subtract Line 11 from Line 10.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
13. Less Line 12 (b) (d) (f).
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
14. Decrease in tax. Subtract Line
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
13 from Line 12.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
I declare under penalties of perjury that this application (including accompanying schedules and statements) has been examined by me and is, to the best of my
knowledge and belief, a true and complete application made in good faith, pursuant to the Georgia Public Revenue Code and Regulations. It is understood that
this is a tentative carry-back adjustment subject to detailed audits and does not constitute a claim for credit or refund.
______________________________________________________
_______________________________________________________
Your Signature
Date
Signature of Preparer other than taxpayer, based on all
Date
information of which the preparer has any knowledge.
______________________________________________________
____________________________________________
Spouse’s Signature
Date
Name, phone number, and identification number of preparer
______________________
ATTACH A COMPLETE COPY OF YOUR FEDERAL RETURN FOR THE LOSS YEAR
Telephone # (optional)

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