Form It-550 - Claim For Refund Of Georgia Income Tax Erroneously Or Illegally Collected
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IT-550 (Rev 7/14)
CLAIM FOR REFUND OF GEORGIA INCOME TAX
STATE OF GEORGIA
DEPARTMENT OF REVENUE
ERRONEOUSLY OR ILLEGALLY COLLECTED
TAXPAYER SERVICES DIVISION
Name
IMPORTANT
Street and Number
SEE INSTRUCTIONS ON
BACK PAGE FOR USES
City or Town
County
State
Zip Code
OF THIS FORM AND
FOR MAILING
ADDRESSES
Federal Employer ID Number
Georgia Withholding Number
Taxpayer’s Social Security Number
Spouse’s Social Security Number
Tax Type:
Corporate
Individual
Withholding
1. Taxable year or period for which taxes were paid.
or fiscal year ending
Calendar year or period
2. Amont of tax paid
$
3. Amunt of tax due
$
4. Amount of refund claimed
$
Claimant believes that this claim should be allowed for the following reasons:
(Attach separate pages if additional space is needed.)
I (we) declare under the penalties of perjury that this claim (including any accompanying schedules and statements) has been examined
by me (us) and to the best of my (our) knowledge and belief is true and correct.
,
Signed:
Date
(Claim must be signed by both husband and wife if
a joint return was filed. Corporate officer should state his/her title.)
THIS SECTION IS FOR OFFICIAL USE ONLY.
I recommend that action on this claim be taken as indicated in the following schedule.
Amount Claimed
$____________________
Amount Rejected
$____________________
Amount Allowed
$____________________
Interest From __________________To ____________ $____________________
Total
$______________________
Examined by:
Approved by:
Based on the facts as stated in this claim and on the certificate of the Examining and Approving Agents, it is directed that
the refund be issued or denied as indicated above.
Date
,
By
Georgia Department of Revenue, Taxpayer Services Division
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