Form IT-560C Fillable Net worth Payment Voucher
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(Check if Address Change) Unchecked (Check if Composite Return) Unchecked (Check if Corporate Return) Unchecked (Check if Name Change) Unchecked (Check if Net Worth Return) Unchecked (checkbox) Unchecked (checkbox) Unchecked (checkbox) Unchecked (Clear All Fields) Clear (Enter 2 Character State Abbreviation) (Enter Amount Paid) (Enter Business Name) (Enter City Name) (Enter FEI Number (99 9999999)) (Enter Fiscal Year Beginning MM/DD/YYYY) (Enter Fiscal Year Ending MMDDYY) (Enter Full Name) (Enter Street Address) (Enter ZIP Code) (Enter Zip+4 Code) (Print Voucher) Print (Sticky Note comment GADOR (text) (text) (text) (text) (text) 1 Download (free) the latest version of Adobe Reader 1 This form is to be used to submit any payment of tax when an extension is requested or enforced 2 Complete the worksheet below to automatically create your payment voucher 2 The amount paid with this form should be claimed on the completed return as credits and payments 2/3/2012 3:42:26 PM 2/3/2012 3:43:10 PM 3 Sign and date the payment voucher 3 This form must be submitted with remittance to pay the tax that will be due as reflected on the final return 4 Click the Print button to print a completed IT560C payment voucher 4 The amount paid is to be credited as a payment on the liability that may be due as indicated on the 5 Cut the payment voucher along the dotted line and mail the voucher and your payment only to Address Change Address Change : Amount Paid : AND/OR NET WORTH TAX WHEN AN EXTENSION HAS BEEN REQUESTED OR IS ENFORCED Atlanta GA 30374 0239 B eginni n g Dat e E nd i n g Da te be paid by the statutory due date An extension of time for filing does not relieve the taxpayer of liability for interest Beginning Date:3 Business Address Check if : 11 CHOOSING TO PRINT THIS COUPON FROM THE WEB BROWSER MENU WILL RESULT IN AN INCOMPLETE DOCUMENT WITH AN INVALID SCANLINE AND WILL DELAY PROCESSING Cit y City : 8 company listed at http://dor georgia gov/approved software vendors completed return Georgia Public Revenue Code Section 48 2 31 stipulates that taxes shall be paid in lawful Composite : Composite Tax Corporate : Net Worth : Corporate Income Tax Current Name :5 Cut along dotted line DO NOT fold staple or paper clip items being mailed DO NOT mail in the worksheet keep this for your records Ending Date:4 extension No penalty for late filing will be assessed if the Georgia return is filed by the extended due date of the Federal return The extension is for filing the return and does not extend the time for paying the tax The tax must FEI Number FEI Number : 2 FOR CORPORATION AND COMPOSITE ONLY For faster and more accurate posting to your account use a payment voucher with a valid scanline from the Georgia Department of Revenue Georgia Department of Revenue s website http://dor georgia gov/ or one produced by an approved software http://www adobe com/products/acrobat/readstep2 html If the tax is not paid by the original due date of the return a penalty of 1/2 of 1% per month of the tax due If you have any questions call: 1 877 423 6711 IMPORTANT Income Tax Year Income Tax Year : Income/Net Worth Payment Voucher Instructions Instructions for Form IT 560C IT 560 C (Rev 06/22/15) IT560C Worksheet KEEP THESE INSTRUCTIONS AND WORKSHEET WITH YOUR RECORDS Mail the completed IT 560C with remittance to: MAIL TO: Make check payable to: Georgia Department of Revenue (Include FEI Number on check) money of the United States free of any expense to the State of Georgia Name (Type or print plainly the exact Corporation Name) Name Change Name Change : Net Worth Tax of liability for interest due on the unpaid balance of tax or penalty for late payment of tax P O Box 740239 Payment of Income Tax PLEASE DO NOT mail this entire page Please cut along dotted line and mail only voucher and payment PLEASE DO NOT STAPLE PLEASE REMOVE ALL CHECK STUBS PLEASE DO NOT STAPLE REMOVE ALL CHECK STUBS Amount Paid $ PO Box 740239 Processing Center Select Type Of Return : 10 Signature of Officer or Agent State : 9 State of Georgia Department of Revenue State Zip Code Street Address Line 1 : Telephone No 1 877 423 6711 Atlanta Georgia 30374 0239 the address on the voucher THIS FORM IS TO BE USED BY CORPORATE TAXPAYERS FOR PAYMENT OF INCOME TAX Title Date UPON COMPLETION OF THIS COUPON PLEASE CLICK THE PRINT BUTTON BELOW TO PRINT A COMPLETED IT 560C AND NOT THE PRINT OPTION FROM THE WEB BROWSER MENU Vendor Code When a taxpayer receives an automatic extension of time in which to file a Federal return Georgia will honor that will be assessed as a late payment penalty The addition of this penalty does not relieve the taxpayer Zip :