Form 500-Nol - Net Operating Loss Adjustment For Other Than Corporations
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1
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4Mailing Address
Georgia Department of Revenue
500-NOL
Processing Center
Georgia Form
PO Box 740318
Page 1
Net Operating Loss Adjustment
Atlanta, GA 30374-0318
For Other Than Corporations
(Rev. 7/13)
YOUR SSN OR FEIN
ATTACH A COMPLETE COPY OF YOUR FEDERAL RETURN FOR THE LOSS YEAR
SPOUSE’S SSN
YOUR FIRST NAME
MI
LAST NAME
SUFFIX
SPOUSE’S FIRST NAME
MI
LAST NAME
SUFFIX
CHECK IF ADDRESS CHANGED
ADDRESS (NUMBER AND STREET or P.O. BOX) (Use 2nd address line for Apt, Suite or Building Numbe
r)
DEPARTMENT USE ONLY
CITY
STATE
ZIP CODE
(COUNTRY IF FOREIGN)
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.
OTHER
FARM LOSS
TYPE OF LOSS:
NORMAL
CASUALTY LOSS
(EXPLAIN IN ATTACHMENT)
(3) YEAR
(5) YEAR
(2) YEAR
PORTION
$ ________________________ $ _________________________ $ _________________________ $ ________________________________
WAS AN ELECTION MADE TO FOREGO THE CARRY-BACK PERIOD MADE? YES
NO
___________________ PRECEDING TAX
___________________ PRECEDING TAX
___________________ PRECEDING TAX
TAX YEAR:
YEAR ENDED ______________________
YEAR ENDED ______________________
YEAR ENDED ______________________
RESIDENCY STATUS
(2) Part-Year Resident
(1) Full-Year Resident
(3) Non-Resident
FILING STATUS
_
(c) Return as filed or
(e) Return as filed or
(a) Return as filed or
(b) Liability after
(d) Liability after
(f) Liability after application
liability as last
application of
liability as last
application of
liability as last
of
Computation of overpayments
determined
carry-back
determined
carry-back
carry-back
determined
1. Federal adjusted gross income
See Page 4 of the instructions
2. Georgia adjustments.
See Page 4 of the instructions
3. Net operating loss.
4. Georgia adjusted gross income
Net total of Lines 1, 2 and 3.
5. Deductions. See Page 4 of the
instructions.
6. Subtract Line 5 from Line 4
7. Exemptions. See Page 4 of
instructions.
8. Taxable Income. Subtract Line
7 from Line 6.
9. Income Tax.
10. Credits.
See Page 4 of the instructions.
11. Tax after credits.
Subtract Line 10 from Line 9.
12. Less Line 11 (b) (d) (f).
13. Deecrease in tax.
13. Decrease in tax.
12 from Line 11.
Subtract Line 12 from Line 11.
Under penalty of perjury , I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct and
complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
______________________________________________________
_______________________________________________________
Your Signature
Date
Signature of Preparer other than Taxpayer
Date
______________________________________________________
_______________________________________________________
Name, Phone Number, and Identification Number of Preparer
Spouse’s Signature
Date
I authorize the Georgia Department of Revenue to electronically notify me
_____________________________________________________
at the e-mail address regarding any updates to my account(s).
E-mail
Telephone # (optional)
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