Form 500x - Amended Individual Income Tax Return - 2013 Page 5
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84
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500X
Georgia Form
Amended Individual Income Tax Return
Georgia Department of Revenue
YOUR SOCIAL SECURITY NUMBER
SCHEDULE 1 ADJUSTMENTS to INCOME BASED on GEORGIA LAW
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ADDITIONS to INCOME
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,
.
00
1. Interest on Non-Georgia Municipal and State Bonds......................................
1.
,
,
.
00
2. Lump Sum Distributions.................................................................................
2.
,
,
.
00
3. Federal deduction for income attributable to domestic production activities.......
3.
(IRC Section 199)
.
,
,
00
4.
Other (Specify)
4.
.
,
,
00
5. Total Additions (Enter sum of Lines 1-4 here)...............................................
5.
SUBTRACTION from INCOME
. 6
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a. Self: Date of Birth
Date of Disability:
Type of Disability:
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00
6a.
Date of Disability:
Type of Disability:
b. Spouse: Date of Birth
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.
00
6b.
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7. Social Security Benefits (Taxable portion from Federal return).....................
7.
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8. Georgia Higher Education Savings Plan.........................................................
8.
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00
. 9
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10. Other Adjustments (Specify)
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Adjustment
Amount
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Adjustment
Amount
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Adjustment
Amount
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Adjustment
Amount
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Total.................................
10.
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.
00
11. Total Subtractions (Enter sum of Lines 6-10 here).........................................
11.
,
,
.
12. Net Adjustments (Line 5 less Line 11.
00
Enter Net Total here and on Line 9 of Page 2)(+ or -) of Form 500X.............
12.
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