Form 500X Amended Individual Income Tax Return (rev. 10/12)

If the return is being amended due to a K 1 include the original and amended K 1 If the return is being amended due to a W 2 include a copy of the W 2 If you are filing an amended return to claim the low income credit the claim must be filed by theend of the 12th month following the close of the taxable year for which the credit may beclaimed If you want all or part of the refund applied to estimated tax indicate this with the year and the Late payment penalty is not due if the return is being amended due to an IRS audit % Not to exceed 100% (Do not use FEDERAL TAXABLE INCOME) (IRC Section 199) (Must enclose G2 A G2 LP and/or G 2RP) (Requires DNR certification for either credit) (See 511 Tax Booklet) (See IT 511 Tax Booklet) 1 Interest on Non Georgia Municipal and State Bonds 1 Other State Credit(s) Tax Credit (See IT 511Tax Booklet) 10 Georgia adjusted gross income (Net total of Line 8 and Line 9) 10 10 Itemized or Standard Deduction 10 Other Adjustments (Specify) 11 Low Income Credit (See IT 511 Tax Booklet) 11a 11 Personal Exemption from Form 500X Page 2 (See IT 511 Tax Booklet) 11a Number on Line 6c 11 Standard Deduction (Do not use FEDERAL STANDARD DEDUCTION) 11a 11 Total Subtractions (Enter sum of Lines 6 10 here) 11b Number on Line 7a 11c Add Lines 11a and 11b Enter total 12 Enter the total of Lines 1 through 11 here and on Line 17 Pg 2 of 500X 12 Net Adjustments (Line 5 less Line 11 Enter Net Total here and on Line 9 of Page 2)(+ or ) of Form 500X 12 Total Deductions and Exemptions: Add Lines 10 and 11c 12 Total Itemized Deductions used in computing Federal Taxable Income 13 Multiply Line 12 by Ratio on Line 9 and enter result 13 Subtract either Line 11c or Line 12c from Line 10; enter balance 13 14 Georgia Taxable Income: Subtract Line 13 from Line 8 Column C Enter here and on Line 15 Page 2 of Form 500X 14a Number on Line 6c 14b Number on Line 7a 14c Add Lines 14a and 14b Enter total 14c 15 Georgia taxable income (Line 13 less Line 14c or Schedule 3 Line 14) 16 Tax (Use Tax Table in the IT 511 Tax Booklet) 16 17 Credits from Schedule 2 of Form 500X 18 Balance (Line 16 less Line 17) if zero or less than zero enter zero 18 19 Georgia Income Tax Withheld on Wages and 1099 s (Enter Tax Withheld Only and enclose W 2s and/or 1099 s) 19 2 Credits from Form IND CR (Rural Physicians Credit Disabled Person Home Purchase or Retrofit Credit Driver Education Credit Disaster Assist ance Credit Qualified Caregiving Expense Credit Georgia National Guard/Air National Guard Credit Child and Dependent Care Expense Credit Adoption Credit Eligible Single Family Residence Credit) 2 Lump Sum Distributions 20 Other Georgia Income Tax Withheld 20 3 Federal deduction for income attributable to domestic production activities 3 Low Emission Vehicle Credit 4 Qualified Education Expense Credit (Individual/Non pass through) 5 Clean Energy Property Credit (Individual/Non pass through) 5 Total Additions (Enter sum of Lines 1 4 here) 6 Retirement Income Exclusion (See IT 511 Tax Booklet) 7 Social Security Benefits (Taxable portion from Federal return) 7 00 7a Number of Dependents (DO NOT include yourself or your spouse) 7a 7b Add Lines 6c and 7a Enter total 7b 8 Federal adjusted gross income (From Federal Form 1040 1040A or 1040 EZ) 8 8 Georgia Higher Education Savings Plan 8 00 9 Adjustments from Schedule 1 (See IT 511 Tax Booklet) 9 Interest on United States Obligations (See IT 511 Tax Booklet ) 9 00 9 RATIO: Divide Line 8 Column C by Line 8 Column A Enter percentage a Federal Itemized Deductions (Schedule A Form 1040) 12a ADDITIONS to INCOME Adjustment Amount 00 Adjustment Amount 00 Amended due to IRS Audit Amended Individual Income Tax Return Amended Individual Income Tax Return amount on Line 28 Attach a copy of your original and amended federal return b Less adjustments: (See IT 511 Tax Booklet) 12b b Self: 65 or over? Beginning black Blind? c Georgia Total Itemized Deductions 12c c Total Standard Deduction (Line 11a + Line 11b) 11c DO NOT USE LINES 9 THRU 14 OF PAGE 2 FORM 500X Fiscal Year Georgia Department of Revenue Georgia Department of Revenue Georgia Department of Revenue Georgia Form 500X Georgia Form 500X Georgia Form 500X (Rev 10/12) Amended Individual Income Tax Return If amount on line 8 9 10 13 or 15 is negative use the minus sign ( ) Example 3 456 INSTRUCTIONS List the state(s) in which the income in Column B was earned and/or to which it was reported multiplied by $2 700 multiplied by $2 700 14a multiplied by $3 000 multiplied by $3 000 14b numbers OffOff OffOff OffOff OffOffOff or Zero Emission Vehicle Credit Page 2 Pass Through Credits from Ownership of Sole Proprietor S Corp LLC or Partnership Interest and Other Credits Please print Spouse: 65 or over? STEP 2 CONT STEP 3INCOME STEP 4DEDUCTIONS STEP 5 TAX COMPUTATION SUBTRACTION from INCOME TAXPAYER EMAIL ADDRESS This return is for calendar year Total Use EITHER Line 11c OR Line 12c (Do not write on both lines) Use this form for the 2012 tax year only Submitting this form for a prior tax year will delay the processing of your return Version 1 Version 1 YOUR SOCIAL SECURITY NUMBER x 1 300= 11b You must list the appropriate Credit Type Code in the space provided If you claim more than four credits enclose a schedule Enter the schedule total on Line 10 See IT 511 Tax Booklet for a list of available credits and their applicable codes YOUR SOCIAL SECURITY NUMBER