Form 500-EZ Form 500-EZ Short Individual Income Tax Return (Fill in on-line, print and mail) (rev. 7/13)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

00 17 (: C) Unchecked (: D) Unchecked (: S) Unchecked (Check box if deceased) (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (COUNTRY IF FOREIGN) (PAYMENT) (REFUND and NO (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (text) (Use Date Format: MM DD YYYY) 1 Adjusted Gross Income from Form 1040EZ 1040 or 1040 A (Cannot exceed $99 999 for Line1) 10 Georgia Wildlife Conservation Fund (No gift less than $1 00) 11 Georgia Children and Elderly Fund (No gift less than $1 00) 12 Georgia Cancer Research Fund (No gift less than $1 00) 13 Statewide Land Conservation Program (No gift less than $1 00) 14 Georgia National Guard Foundation (No gift less than $1 00) 15 Dog and Cat Sterilization Fund (No gift less than $1 00) 16 Save the Cure Fund (No gift less than $1 00) 17 Georgia Student Finance Authority Fund (No gift less than $1 00) 18 18 19 (If you owe) Add Line 8 and Line 18 Complete and mail 525 TV with return and payment 2 If your filing status is single enter $5 000 00 married filing joint enter $10 400 00 20 (If you are due a refund) Subtract Line 18 from Line 9 THIS IS YOUR REFUND 2013 YOUR SOCIAL SECURITY NUMBER 2013(Approved web version) 20a Direct Deposit (For U S Accounts Only) Type: Checking Savings N u m b e r 20b Debit Card 2Page 3 Subtract Line 2 from Line 1 If Line 2 is larger than Line 1 enter zero 4 Find the tax on the amount on Line 3 (Use Tax Table in the Tax Booklet on Pages 20 22) 48 2 31 requires that taxes shall be paid in lawful money of the United States free of any expenses to the State of Georgia 5 Low income tax credit (Not allowed if you are claimed as a dependent on another return) 5a 5b 00 5c 6 Line 4 Less Line 5c If zero or less than zero enter zero 6 7 Georgia income tax withheld (Enter tax withheld only and enclose W 2s 1099s etc ) 8 If Line 6 is larger than Line 7 subtract Line 7 from Line 6 THE AMOUNT OF TAX YOU OWE 9 If Line 7 is larger than Line 6 subtract Line 6 from Line 7 THE AMOUNT OF YOUR OVERPAYMENT Account Add Line 10 thru Line 17 enter total here ADDRESS (NUMBER AND STREET or P O BOX) (Use 2nd address line for Apt Suite or Building Number) AFFIX ATLANTA GA 30374 0380 ATLANTA GA 30374 0399 BALANCE DUE) CHECK IF ADDRESS HAS CHANGED CITY (Please insert a space if the city has multiple names) COMPUTATION COMPUTATIONSTEP CONTINUEDMake check for this amount payable to the GEORGIA DEPARTMENT OF REVENUE DEPARTMENT USE ONLY DEPOSIT Direct Deposit or Debit Card a paper check Do not use dollar signs commas or decimals Round off figures for easier computations These have been preprinted for your convenience Do you want to authorize DOR to discuss this return with the electronically notify me at the below e mail address Georgia Department of Revenue GEORGIA DEPARTMENT OF REVENUE GEORGIA DEPARTMENT OF REVENUE Georgia Form 500EZ Georgia Form 500EZ (Rev 7/13) Page 1Short Individual Income Tax Return Green Label: HERETAXPAYER I authorize the Georgia Department of Revenue to INFORMATIONTAX Keep numbers inside boxes LABEL N u m b e r NAME OF PREPARER OTHER THAN TAXPAYER named preparer Yes OPTIONS or Debit Card If you do not select Direct PHONE NUMBER PHONE NUMBER PO BOX 740380 PO BOX 740399 PREPARER S FEIN PREPARER S SSN/PTIN PROCESSING CENTER PROCESSING CENTER Blue Label: processing costs by choosing Direct Deposit R o u t i n g See Tax Booklet on Page 9 Select one option only See booklet page 13 Short Individual Income Tax Return Sign and date your return See Tax Booklet on Page 6 for signature requirements concerning deceased taxpayers Signature of Preparer SIGNATURES ARE REQUIRED ON PAGE 2 OF THIS FORM SIGNATURESTEP Special Program Code Spouse s Signature (Check box if deceased) SPOUSE S SSN# STATE USE ONLY STATE ZIP CODE SUFFIX SPOUSE S FIRST NAME MI LAST NAME TAXPAYER S EMAIL ADDRESS regarding any updates to my account(s) Taxpayer s Signature true correct and complete Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge Georgia Public Code Section Under penalty of perjury I declare that I have examined this return including accompanying schedules and statements and to the best of my knowledge and belief it is Use Federal Adjusted Gross Income NOT Federal Taxable Income on Line 1 below Use label only if correct If not print or type name(s) address and social security number(s) WHEN COMPLETING YOUR RETURN PLEASE REMEMBER TO: will be issued You are a full year Georgia resident You are not 65 or over or blind You can help eliminate $1 Million of You do not have any adjustments to Federal Adjusted Gross Income 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 YOU MAY USE FORM 500EZ IF: 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 FIRST NAME MI LAST NAME SUFFIX Your income does not exceed $99 999 and you do not itemize deductions YOUR SSN#