Instructions For Form Ga-9465 - Installment Payment Agreement Request - Georgia Department Of Revenue

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Form GA-9465 (Rev. 6/2009)
Page 3
When is this form due?
There is no specific due date for this form. We recommend,
however, that you file this form as soon as you are aware that you
are unable to pay your tax liability due to a financial hardship. If you
APPLING, ATKINSON, BACON,
have already received a proposed or official assessment from the
BEN HILL, BERRIEN,
Department, you should return this form within 10 days of the
BRANTLEY, CAMDEN,
Georgia Department of Revenue
assessment notice date.
CHARLTON, CLINCH, COFFEE,
Douglas Regional Office
COOK, ECHOLS, IRWIN,
To what address do I mail this form?
1214 N. Peterson Avenue
JEFF DAVIS, LANIER,
Douglas, GA 31533
LOWNDES, MONTGOMERY,
• Income tax liability
PIERCE, TELFAIR, TOOMBS,
TREUTLEN, WARE, WAYNE,
If your installment payment plan request involves an income tax
WHEELER, WILCOX
liability, please return your completed form, along with any
attachments, using any of the following methods:
By mail: Georgia Department of Revenue
Installment Payment Unit
1800 Century Blvd., Suite 18225
Georgia Department of Revenue
CARROLL, COBB,
Atlanta, Georgia 30345
Lithia Springs Regional Office
DOUGLAS, PAULDING
351 Thornton Road, Suite 101
By Fax:
(404) 417-4491
Lithia Springs, GA 30122-1596
By E-mail: ipa@dor.ga.gov
• Sales and use tax liability
If your installment payment plan request involves a sales and use
BALDWIN, BIBB, BLECKLEY,
tax liability, please return your completed form, along with any
CRAWFORD, DODGE,
attachments, to the Georgia Department of Revenue at the address
Georgia Department of Revenue
DOOLY, HANCOCK,
below that applies to you.
If you have a business in multiple
HOUSTON, JASPER,
Macon Regional Office
JOHNSON, JONES, LAMAR,
counties, choose a single mailing address.
630 North Avenue, Suite B
LAURENS, MACON,
Macon, GA 31211-1493
IF your business is in one of
MONROE, PEACH, PULASKI,
the following counties. . .
THEN use this address . . .
PUTNAM, TWIGGS, UPSON,
WASHINGTON, WILKINSON
BAKER, BROOKS, CALHOUN,
CLAY, COLQUIT, CRISP
Georgia Department of Revenue
DECATUR, DOUGHERTY
Albany Regional Office
EARLY, GRADY, LEE,
1105-D W. Broad Ave.
MILLER, MITCHELL,
Georgia Department of Revenue
Albany, GA 31707
DEKALB, GWINNETT,
RANDOLPH, SEMINOLE,
North East Metro Office
NEWTON, ROCKDALE
SUMTER, TERRELL,
1800 Century Blvd, NE
THOMAS, TIFT, TURNER
Atlanta, GA 30345-3205
BANKS, BARROW, CLARKE,
DAWSON, ELBERT, FORSYTH,
BARTOW, CATOOSA,
Georgia Department of Revenue
FRANKLIN, GREENE,
CHATTOOGA, CHEROKEE,
Georgia Department of Revenue
HABERSHAM, HALL, HART,
Athens Regional Office
DADE, FANNIN, FLOYD,
Rome Regional Office
JACKSON, LUMPKIN,
3700 Atlanta Hwy., Suite 268
GILMER, GORDON,
MADISON, MORGAN,
1401 Dean Street, Suite E
Athens, GA 30606
HARALSON, MURRAY,
OCONEE, OGLETHORPE,
Rome, GA 30161-6494
PICKENS, POLK, WALKER,
RABUN, STEPHENS, TOWNS,
WHITFIELD
UNION, WALTON, WHITE
Georgia Department of Revenue
BUTTS, CLAYTON,
Georgia Department of Revenue
Atlanta Regional Office
BRYAN, BULLOCH, CANDLER,
FAYETTE, FULTON,
Savannah Regional Office
CHATHAM, EFFINGHAM,
4245 International Parkway
HENRY, PIKE, SPALDING
6606 Abercorn Street, Suite 220
EVANS, GLYNN, LIBERTY,
Hapeville, GA 30354
Savannah, GA 31405
LONG, MCINTOSH, TATTNALL
BURKE, COLUMBIA, EMANUEL,
Georgia Department of Revenue
GLASCOCK, JEFFERSON,
Augusta Regional Office
JENKINS, LINCOLN, MCDUFFIE,
Where do I get help?
130 Davis Road
RICHMOND, SCREVEN,
Martinez, GA 30907-2386
TALIAFERRO, WARREN, WILKES
• Visit our web site at
• For sales and use tax, contact the revenue agent assigned to
CHATTAHOOCHEE, COWETA,
Georgia Department of Revenue
your account at the appropriate regional office. Phone numbers
HARRIS, HEARD, MARION,
Columbus Regional Office
of all regional offices are located on the Department’s website.
MERIWETHER, MUSCOGEE,
1501 13th Street, Suite A
QUITMAN, SCHLEY, STEWART,
• For income tax, contact the Installment Payment Plan Unit at
Columbus, GA 31901
TALBOT, TAYLOR, TROUP,
(404) 417-6486.
WEBSTER

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