Georgia Individual Income Tax Return (Short Version)

Individual Income Tax Return (Short Version)
GA Form 500EZ Short Individual Income Tax Return
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Georgia Form

500EZ

RESET ALL

(Rev. 05/31/23)

Short Individual Income Tax Return

YOUR SSN#

Georgia Department of Revenue

2023 (Approved web version)
P ag e 1

SPOUSE’S SSN#
STATE
ISSUED

YOUR DRIVER’S

Select
LICENSE/STATE ID

YOUR FIRST NAME

MI

LAST NAME (For Name Change See IT-511 Tax Booklet)

SUFFIX

SPOUSE’S FIRST NAME

MI

LAST NAME

SUFFIX

ADDRESS (NUMBER AND STREET or P.O. BOX) (Use 2nd address line for Apt, Suite or Building Number)

CHECK IF ADDRESS CHANGED
DEPARTMENT USE ONLY

CITY (Please insert a space if the city has multiple names)

STATE

ZIP CODE

(COUNTRY IF FOREIGN)

Use Federal Adjusted Gross Income, NOT Federal Taxable Income, on Line 1 below
1. Adjusted Gross Income from Federal Form 1040 (Cannot exceed $99,999 for Line 1)..........................

1.

2. If your filing status is single, enter $8,100, married filing joint, enter $14,500 ............................................

2.

3. Subtract Line 2 from Line 1. If Line 2 is larger than Line 1, enter zero ...........................................................

3.

4. Find the tax on the amount on Line 3. (Use the Tax Rate Schedule in the IT-511 Tax Booklet).....................

4.

5. Low income tax credit. (Not allowed if you are claimed as a dependent on another return) 5a.

5b.

6. Subtract Line 5c from Line 4. If zero or less than zero, enter zero..........................................................

6.

7. Georgia income tax withheld (Enter tax withheld only and include W-2s and 1099s) .........................

7.

8. If Line 6 is larger than Line 7, subtract Line 7 from Line 6. THE AMOUNT OF TAX YOU OWE .................

8.

9. If Line 7 is larger than Line 6, subtract Line 6 from Line 7. THE AMOUNT OF YOUR OVERPAYMENT...........

9.

10. Georgia Wildlife Conservation Fund (No gift less than $1.00).................................................................

10.

11. Georgia Fund for Children and Elderly (No gift less than $1.00)............................................................

11.

12. Georgia Cancer Research Fund (No gift less than $1.00).......................................................................

12.

13. Georgia Land Conservation Program (No gift less than $1.00).........................................................................

13.

14. Georgia National Guard Foundation (No gift less than $1.00)..................................................................

14.

15. Dog and Cat Sterilization Fund (No gift less than $1.00)........................................................................

15.

16. Saving the Cure Fund (No gift less than $1.00).....................................................................................

16.

PLEASE COMPLETE INCOME STATEMENT DETAILS ON PAGE 3.

5c.

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EZ

Georgia Form 500

Short Individual Income Tax Return
Georgia Department of Revenue

2023

YOUR SOCIAL SECURITY NUMBER

Page 2

17. Realizing Educational Achievement Can Happen (REACH) Program (No gift less than $1.00).........

17.

18. Public Safety Memorial Grant (No gift less than $1.00).........................................................................

18.

19. Disabled Veterans’ Scholarship Fund (No gift less than $1.00)............................................................

19.

20. Penalty: Late Payment and/or Late Filing ...............................................................................................

20.

21. Interest ....................................................................................................................................................

21.
2

2
22. Add Lines 10 thru Line 21, enter total here................................................................................................
. (If you owe) Add Line 8 and Line 22.
23.
2 Complete and mail 525-TV with return and payment
Make check for this amount payable to the GEORGIA DEPARTMENT OF REVENUE.....................
Mail To: GEORGIA DEPARTMENT OF REVENUE PROCESSING CENTER, PO BOX 740399
ATLANTA, GA 30374-0399

2
22.

24.
2 . (If you are due a refund) Subtract Line 22
2 from Line 9. THIS IS YOUR REFUND..............................
Mail To: GEORGIA DEPARTMENT OF REVENUE PROCESSING CENTER, PO BOX 740380
ATLANTA, GA 30374-0380

24.
2

23.
2

If you do not enter Direct Deposit information or if you are a first time filer you will be issued a paper check.

24a. Direct Deposit (For U.S. Accounts Only)

Type: Checking

Savings

Account
Number

Routing
Number

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 the taxpayer(s), this declaration is based on all information of which the preparer has knowledge.

Taxpayer’s Signature

(Check box if deceased)

Taxpayer’s Date of Death

Spouse’s Signature

(Check box if deceased)

Spouse’s Date of Death

Taxpayer’s Signature Date

Taxpayer’s Phone Number

Spouse’s Signature Date

By providing my e-mail address I am authorizing the Georgia Department of Revenue to electronically notify me at the below e-mail address regarding any updates to
my account(s).

Taxpayer’s E-mail Address
I authorize DOR to discuss this return
with the named preparer.

Preparer’s Phone Number

Signature of Preparer
Name of Preparer Other Than Taxpayer

Preparer’s FEIN

Preparer’s Firm Name

Preparer’s SSN/PTIN/SIDN

PLEASE COMPLETE INCOME STATEMENT DETAILS ON PAGE 3.

ALL PAGES (1-3) ARE REQUIRED FOR PROCESSING

RESET PAGE 3

PREVIOUS PAGE

EZ

Georgia Form 500

Short Individual Income Tax Return
Georgia Department of Revenue

2023

YOUR SOCIAL SECURITY NUMBER

Page 3

INCOME STATEMENT DETAILS Only enter income on which Georgia tax was withheld. Enter information from W-2s and 1099s in the section below.
(INCOME STATEMENT B)

(INCOME STATEMENT A)

(INCOME STATEMENT C)

1. WITHHOLDING TYPE:

1. WITHHOLDING TYPE:

1.

WITHHOLDING TYPE:

2.

EMPLOYER/PAYER FEDERAL
ID NUMBER (FEIN)
SSN

2.

3.

EMPLOYER/PAYER STATE WITHHOLDING ID

3. EMPLOYER/PAYER STATE WITHHOLDING ID

3. EMPLOYER/PAYER STATE WITHHOLDING ID

4.

GA WAGES / INCOME

4. GA WAGES / INCOME

4. GA WAGES / INCOME

5.

GA TAX WITHHELD

5. GA TAX WITHHELD

5. GA TAX WITHHELD

W-2

1099

W-2

1099

2.

EMPLOYER/PAYER FEDERAL
ID NUMBER (FEIN)
SSN

W-2

1099

EMPLOYER/PAYER FEDERAL
ID NUMBER (FEIN)
SSN

(INCOME STATEMENT F)

(INCOME STATEMENT E)

(INCOME STATEMENT D)

W-2

W-2

1099 1. WITHHOLDING TYPE:

1099

W-2

1. WITHHOLDING TYPE:

1099

1.

WITHHOLDING TYPE:

2.

EMPLOYER/PAYER FEDERAL
ID NUMBER (FEIN)
SSN

2. EMPLOYER/PAYER FEDERAL

2. EMPLOYER/PAYER FEDERAL

3.

EMPLOYER/PAYER STATE WITHHOLDING ID

3. EMPLOYER/PAYER STATE WITHHOLDING ID

3. EMPLOYER/PAYER STATE WITHHOLDING ID

4.

GA WAGES / INCOME

4. GA WAGES / INCOME

4. GA WAGES / INCOME

5.

GA TAX WITHHELD

5. GA TAX WITHHELD

5. GA TAX WITHHELD

ID NUMBER (FEIN)

SSN

ID NUMBER (FEIN)

SSN

YOU MAY USE FORM 500EZ IF:

You are not 65 or over, or blind.
Your filing status is single or married filing joint and you do not claim any exemptions other than yourself or yourself and your spouse.
Your income does not exceed $99,999 and you do not itemize deductions.
You are a full-year Georgia resident.
You had wages, salaries, tips, dividends, and interest income only. Do not use this form if you paid or are claiming a credit of estimated tax
or the timber tax credit.
You do not have any adjustments to Federal Adjusted Gross Income.

WHEN COMPLETING YOUR RETURN PLEASE REMEMBER TO:

Print or type name(s), address and social security number(s).
Keep numbers inside boxes.
Do not use dollar signs, commas or decimals. Round off figures for easier computations. These have been preprinted for your convenience.
Sign and date your return. See IT-511 Tax Booklet for signature requirements.

ALL PAGES (1-3) ARE REQUIRED FOR PROCESSING

Dos and Don’ts Checklist for the Individual/Fiduciary (525-TV) Payment Voucher
Payments can be made electronically on the Georgia Tax Center (GTC) gtc.dor.ga.gov/ .

Do:

Use a payment voucher with a valid scanline.
Only complete this voucher if you owe taxes.
Complete the voucher in its entirety.
Write your SSN or FEIN on your check or money order.
Make check or money order payable to: Georgia Department of Revenue
Remember if the due date falls on a weekend or holiday, the tax shall be due on the next day that
is not a weekend or holiday.
Mail your voucher and payment to the address listed below if your return was filed electronically.
Processing Center
Georgia Department of Revenue
P O Box 740323
Atlanta, Georgia 30374-0323

Mail your return, payment voucher and payment to the address that appears on the return if filing
a paper return.
Do not:
Mail this entire page.
Staple your payment and voucher together.
Print on both sides of the paper.
Handwrite any information.
Georgia Public Revenue 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.
Cut along dotted line
Individual or Fiduciary Name and Address:

525-TV (Rev. 06/05/23)

Individual and Fiduciary Payment Voucher

Amended Return
Taxpayer’s SSN or Fiduciary FEIN

Paper Return

Electronically Filed

Spouse’s SSN (if joint or combined return)

Tax Year

Type of Return: [X]09-INDIVIDUAL
Daytime Telephone Number

PLEASE DO NOT STAPLE. REMOVE ALL CHECK STUBS.

PROCESSING CENTER
GEORGIA DEPARTMENT OF REVENUE
PO BOX 740323
ATLANTA GA 30374-0323

Amount Paid

$

Vendor Code

040