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500
Georgia Form
Individual Income Tax Return
Georgia Department of Revenue
2015
YOUR SOCIAL SECURITY NUMBER
DO NOT USE LINES 9 THRU 14 OF PAGE 3 FORM 500
SCHEDULE 3 COMPUTATION OF GEORGIA TAXABLE INCOME FOR ONLY PART-YEAR
RESIDENTS AND NONRESIDENTS.
Income earned in another state as a Georgia resident is taxable but other state(s)
tax credit may apply. See IT-511 Tax Booklet.
FEDERAL INCOME AFTER GEORGIA ADJUSTMENT
INCOME NOT TAXABLE TO GEORGIA
GEORGIA INCOME
(COLUMN A)
(COLUMN C)
(COLUMN B)
1.
WAGES, SALARIES, TIPS, etc
1.
WAGES, SALARIES, TIPS, etc
1.
WAGES, SALARIES, TIPS, etc
.
.
.
00
00
00
4,
2.
INTERESTS AND DIVIDENDS
2.
INTERESTS AND DIVIDENDS
2.
INTERESTS AND DIVIDENDS
.
.
.
00
00
00
3.
BUSINESS INCOME OR (LOSS)
3. BUSINESS INCOME OR (LOSS)
3.
BUSINESS INCOME OR (LOSS)
.
.
.
00
00
00
4.
OTHER INCOME OR (LOSS)
4. OTHER INCOME OR (LOSS)
4. OTHER INCOME OR (LOSS)
.
.
.
00
00
00
5. TOTAL INCOME: TOTAL LINES 1 THRU 4
5. TOTAL INCOME: TOTAL LINES 1 THRU 4
5. TOTAL INCOME: TOTAL LINES 1 THRU 4
.
.
.
00
00
00
6. TOTAL ADJUSTMENTS FROM FORM 1040
6. TOTAL ADJUSTMENTS FROM FORM 1040
6. TOTAL ADJUSTMENTS FROM FORM 1040
.
.
.
00
00
00
7. TOTAL ADJUSTMENTS FROM FORM 500,
7. TOTAL ADJUSTMENTS FROM FORM 500,
7. TOTAL ADJUSTMENTS FROM FORM 500,
SCHEDULE 1, PAGE 5
SCHEDULE 1, PAGE 5
SCHEDULE 1, PAGE 5
.
.
.
00
00
00
8. ADJUSTED GROSS INCOME:
8. ADJUSTED GROSS INCOME:
8. ADJUSTED GROSS INCOME:
LINE 5 PLUS OR MINUS LINES 6 AND 7
LINE 5 PLUS OR MINUS LINES 6 AND 7
LINE 5 PLUS OR MINUS LINES 6 AND 7
.
.
.
00
00
00
9.
RATIO: Divide Line 8, Column C by Line 8, Column A. Enter percentage..........
9.
% Not to exceed 100%
.
00
10. Itemized
or Standard Deduction
(See IT-511 Tax Booklet)...................
10.
11. Personal Exemption from Form 500 (See IT-511 Tax Booklet)
.
00
OR
multiply by $2,700 for filing status A or D
............
11a. Number on Line 6c.
11a.
multiply by $3,700 for filing status B or C
.
00
11b. Number on Line 7a.
multiply by $3,000..................................................
11b.
.
00
11c. Add Lines 11a. and 11b. Enter total.....................................................................
11c.
.
00
12. Total Deductions and Exemptions:
Add Lines 10 and 11c............................
12.
.
00
13. Multiply Line 12 by Ratio on Line 9 and enter result ..........................................
13.
14. Georgia Taxable Income: Subtract Line 13 from Line 8, Column C
.
00
Enter here and on Line 15, Page 3 of Form 500...............................................
14.
List the state(s) in which the income in Column B was earned and/or to which it was reported.
1.
3.
2.
4.
1
2
3
4
5
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12
13
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