Form G-2-A - Withholding On Distributions To Nonresident Members/shareholders

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Form G-2-A
WITHHOLDING ON DISTRIBUTIONS TO NONRESIDENT MEMBERS/SHAREHOLDERS
TAX YEAR
1. PAYER’S STATE ID NUMBER
2. PAYER’S FEDERAL ID NUMBER
. 3
P
A
Y
E
R
S ’
N
A
M
E
A
N
D
A
D
D
R
E
S
S
. 4
R
E
C
P I
E I
N
’ T
S FEIN/ID NUMBER
5. RECIPIENT’S NAME AND ADDRESS
6. AMOUNT OF DISTRIBUTION CREDITED BUT NOT PAID
. 7
A
M
O
U
N
T
O
F
D
S I
T
R
B I
U
I T
O
N PAID
. 8
G
E
O
R
G
A I
T
A
X
W
T I
H
H
E
L
D
GEORGIA DEPARTMENT OF REVENUE
PROCESSING CENTER
P.O. BOX 105685
ATLANTA, GA 30348-5685
COPY 1- STATE COPY
INSTRUCTIONS FOR COMPLETING FORM G-2-A
Enter Tax Year of Distribution
Box 1.
Enter Georgia Withholding Number.
Box 2.
Enter Federal Identification Number.
Box 3.
Enter name and address of payer.
Box 4.
Enter social security number if recipient is an individual or federal identification number if
recipient is a business.
Box 5.
Enter name and address of member/shareholder.
Box 6.
Enter the amount of distribution credited but not paid.
Box 7.
Enter amount of distribution paid.
Box 8.
Enter amount of Georgia income tax withheld.
On or before the earlier of the date the return is filed or the due date for filing the income
tax return of the flow through entity (without extension), all G-2-A’s issued for the calendar
year should be mailed along with Form G-1003 to:
GEORGIA DEPARTMENT OF REVENUE
PROCESSING CENTER
P.O. BOX 105685
ATLANTA, GA 30348-5685
Mail your payment with the GA-V Payment Voucher to:
Georgia Department of Revenue
Processing Center
P. O. Box 740387
Atlanta, GA 30374-0387
(Rev. 1/09)

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