Form 500 Es - Individual Estimated Tax - 2011 printable pdf download

Form 500 Es - Individual Estimated Tax - 2011

State 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 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

1. Taxpayer’s SSN :

2. Spouse’s SSN :

3. Name : .............................

4. Street Address Line 1 :

5. Street Address Line 2 :

6. City :

7. State:

8. Zip:

9. Check Type Of Return : ..........................................

Individual :

Fiduciary:

10. Check If Address Change : ........................................................................................................

11. Calendar Year or Fiscal Year Ending :

Select

12. Due Date : .................................................................

Select

13. Amount Paid : ..........................................................

Clear

Form 500 Es - Individual Estimated Tax - 2011