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Georgia Form
(Rev. 08/17/15)
Georgia Financial Institutions
Business Occupation Tax Return
Tax Year_____________
(Year in Which Tax is Paid)
Address Change
Name Change
Form Type
A. Federal Employer I.D. Number
Name
(Type or Print Exact Corporate Name)
Original ( ) Amended ( )
B. Date of Incorporation
Business Address
Form of Incorporation
Federal ( ) State ( ) Mutual ( )
C. Incorporated Under Laws of What State City/Town
County
State
Zip Code
Accounting Method
Cash ( ) Accrual ( )
State
D. Date Admitted to Georgia
Location of Books for Audit (City)
NAICS Code
Schedule 1 - Computation of Gross Receipts (Banks and Mutual Financial Institutions):
1. Gross Receipts (See Instructions) ............................................................................... 1.
2. Additions (Line 4, Schedule 5, Page 2) ....................................................................... 2.
3. Total (Line 1 plus Line 2) .............................................................................................. 3.
4. Exclusions (Line 4, Schedule 6, Page 2) ..................................................................... 4.
5. Balance (Line 3 less Line 4) ......................................................................................... 5.
6. Deductions (Line 7, Schedule 7, Page 2) .................................................................... 6.
7. Balance (Line 5 less Line 6) ......................................................................................... 7.
8. Adjusted Gross Receipts (Line 3, Schedule 8, Page 2) .............................................. 8.
Schedule 2 - Calculation of State Occupation Tax
1. Adjusted Gross Receipts (Line 8, Schedule 1) .......................................................... 1.
2. Occupation Tax Rate ................................................................................................ . . .
.
2.
x .0025
3. Occupation Tax Due ..................................................................................................... 3.
Schedule 3 - Amount Paid With Return
1. Occupation Tax (Line 3, Schedule 2) ........................................................................... 1.
2. Interest Due (See Instructions) .................................................................................... 2.
3. Balance of Tax & Interest Due with Return .................................................................. . 3.
Schedule 4 - Amount of Credit to be Claimed on Corporate Tax Return
1. Occupation Tax (Line 1, Schedule 3 Above) ................................................................ 1.
Business License Taxes Paid,
Copy of Form(s) PT440 Must Be Attached to this Return
2.
2.
3. Total Credit to be Claimed Against Corporate Income Tax .......................................... 3.
DECLARATION: I/We declare, under penalties of perjury that I/we have examined this return (including accompanying schedules and statements) and to the
best of my/our knowledge and belief, it is true, correct, and complete. If prepared by a person other than taxpayer, this declaration is based on all
information of which the preparer has knowledge. Georgia Public Code Section 48-2-31 stipulates that taxes shall be paid in lawful money of the United
States, free of any expense to the State of Georgia.
_____________________________
_____________________________
Signature of Officer
Signature of Individual or Firm Preparing Return
_____________________________
_____________________________
Title
Date
Preparing Firm’s Name
_____________________________
_____________________________
Telephone Number
Identification or Social Security Number
MAKE CHECK PAYABLE TO TAXPAYER SERVICES DIVISION AND MAIL TO:
GEORGIA DEPARTMENT OF REVENUE
PROCESSING CENTER, P O BOX 740320, ATLANTA, GEORGIA 30374-0320
THIS RETURN IS DUE ON MARCH 1ST OF THE YEAR FOLLOWING THE CALENDAR YEAR IN WHICH
GROSS RECEIPTS ARE COMPLETED