Form 39R (Resident) Idaho Supplemental Schedule

1 Credit for contributions to Idaho educational entities 1 2 Credit for contributions to Idaho youth and rehabilitation facilities 2 2 State income tax refund if included in federal income 3 Credit for live organ donation expenses 3 3 Interest from U S Government obligations 4 Insulation of Idaho residence 4 Total credits Add lines 1 through 3 Enter total here and on Form 40 line 23 4 5 Alternative energy devices deduction 6 Child/dependent care Include federal Form 2441 7 Social security and railroad benefits if included in federal income 8 Retirement benefits deduction Complete Part C 9 Technological equipment donation Acquired Type of Device Total Cost Percent Developmental Disability See instructions page 25 e Add lines 5a through 5d Can't exceed $5 000 Enter here and on Form 40 line 10 Enter here and on Form 40 line 43 (Credit cannot be claimed if you took $1 000 deduction Facilities and Live Organ Donation Expenses See instructions page 24 Financial institution Account number First Name Last Name First Name Last Name Social Security Number Idaho net operating loss carryback Enter total here on Part B line 15 ) one half of his/her support? You and your spouse do not qualify provide more than one half of his/her support? You and your spouse may qualify 09 01 11 1 Did you maintain a home for an immediate family member age 65 or older and provide more than 1 Federal net operating loss carryover included in Form 40 line 7 1 Idaho net operating loss carryover 1 Idaho tax Form 40 line 20 1 If single enter $27 876 or if married filing jointly enter $41 814 10 Idaho capital gains deduction Include Form CG 11 Active duty military pay earned outside of Idaho 12 Adoption expenses 13 Idaho medical savings account Contributions Interest 14 Idaho college savings program 15 Maintaining a home for the aged and/or developmentally disabled 16 Idaho lottery winnings less than $600 per prize 17 Income earned on a reservation by an American Indian 18 Health insurance premiums 19 Long term care insurance 2 Capital loss carryover incurred outside the state before becoming an Idaho resident 2 Did you maintain a home for an immediate family member with a developmental disability and 2 Federal Railroad Retirement benefits received 2 Other state's adjusted income 20 Worker's compensation insurance 21 Bonus depreciation Include computations 22 Other subtractions Include explanation 23 Total subtractions Add lines 1 through 4 and 5e through 22 3 Idaho adjusted income from Form 40 line 11 3 List each family member you are claiming: 3 Non Idaho state and local bond interest and dividends 3 Social Security benefits received 4 Divide line 2 by line 3 Enter percentage here 4 Idaho college savings account withdrawal 5 Bonus depreciation Include computations 4 Line 1 minus lines 2 and 3 If less than zero enter zero 4 Total amount claimed ($100 for each qualifying member but not more than $300) 5 Multiply line 1 by line 4 Enter amount here 6 Other state's tax due less its income tax credits 5 Qualified retirement benefits included in federal income 6 Enter the smaller of line 4 or 5 here and on Part B line 8 6 Other additions Include explanation 7 Enter the smaller of lines 5 or 6 here and on Form 40 line 22 7 Total additions Add lines 1 through 6 Enter here and on Form 40 line 8 A Additions See instructions page 19 B Subtractions See instructions page 19 C Retirement Benefits Deduction See instructions page 24 for qualified retirement benefits Check here if D Credit for Income Tax Paid to Other States See instructions page 24 Date of Birth of developmentally disabled E Credits for Contributions to Idaho Educational Entities Idaho Youth and Rehabilitation EFO00088 EFO00088p2 09 01 11 F Maintaining a Home for a Family Member Age 65 or Older or a Family Member With a Family Member For Form 40 Resident Returns Only Form 39R 2011 G Dependents: (Continued from Form 40 page 1) IDAHO SUPPLEMENTAL SCHEDULE Include a copy of the income tax return and a separate Form 39R for each state for which a credit is claimed Name of Family Member Name(s) as shown on return of Family Member Page 2 Relationship to Person Filing Return Social Security Number Social Security Number This credit is being claimed for taxes paid to: (State name)