Form 39NR Idaho Supplemental Schedule

08 16 12 1 Credit for contributions to Idaho educational entities 1 1 Did you maintain a home for an immediate family member age 65 or older and provide more than one half of his/her support? You and your spouse do not qualify 1 Idaho adjusted income from Form 43 line 31 Column B 1 Idaho tax Form 43 line 42 2 Credit for contributions to Idaho youth and rehabilitation facilities 2 2 Did you maintain a home for an immediate family member with a developmental disability and 2 Federal adjusted gross income earned in other state adjusted for 2 Other state's adjusted income See instructions 2 State income tax refund included in Form 43 line 28 Column A 3 Amount of income taxed by Idaho and also taxed by another state 3 Credit for live organ donation expenses 3 3 Idaho adjusted income from Form 43 line 31 Column B 3 Interest from U S Government obligations 3 List each family member you are claiming: 4 Child/dependent care Include federal Form 2441 4 Divide line 2 by line 3 Enter percentage here 4 Idaho tax Form 43 line 42 4 Total amount claimed ($100 for each qualifying member but not more than $300) 4 Total credits Add lines 1 through 3 Enter total here and on Form 43 line 44 4 5 Divide line 3 by line 1 Enter percentage here 5 Multiply line 1 by line 4 Enter amount here 5 Social security and railroad benefits included in Form 43 line 28 Column A 6 Idaho capital gains deduction Include Form CG 6 Multiply line 4 by line 5 6 Other state's tax due less its income tax credits 7 Enter the smaller of line 5 or 6 here and on Form 43 line 43 7 Idaho resident Active duty military pay earned outside of Idaho 7 Other state's tax due less its income tax credits 8 Divide line 3 by line 2 Enter percentage here 8 Idaho medical savings account contributions and interest 9 Idaho college savings program 9 Multiply line 7 by line 8 a If single enter $30 156 if married filing jointly enter $45 234 Acquired Type of Device Total Cost Percent b Federal Railroad Retirement received c Social Security benefits received Column A Total Column B Idaho Column B add lines 21 22i 24 and 25 Enter here and on Form 43 line 30 d Balance Line 22a minus lines 22b and 22c If less than zero enter zero Developmental Disability See instructions page 33 e Qualified retirement benefits included in federal gross income Enter here and on Form 43 line 62 (Credit cannot be claimed if you took $1 000 deduction f Column A benefits Smaller of line 22d or line 22e Facilities and Live Organ Donation Expenses See instructions page 32 Financial institution Account number First Name Last Name First Name Last Name Social Security Number g Qualified retirement benefits included in Idaho gross income h Divide line 22g by line 22e i Column B benefits deduction Multiply line 22f by line 22h Idaho modifications See instructions Idaho net operating loss carryback Enter total here Nonresidents cannot claim this credit Idaho residents on active military duty complete Part D below on Part B line 11 ) provide more than one half of his/her support? You and your spouse may qualify 1 Idaho net operating loss carryover 1 Non Idaho state and local bond interest and dividends 2 Idaho college savings account withdrawal 10 Adoption expenses 10 Enter the smaller of line 6 or 9 here and on Form 43 line 43 11 Maintaining a home for the aged and/or developmentally disabled 12 Idaho lottery winnings less than $600 per prize 13 Income earned on a reservation by an American Indian 14 Worker's compensation insurance 15 Partner's and shareholder's pass through subtractions 16 Energy efficiency upgrades 17 Technological equipment donation 18 Health insurance premiums 19 Long term care insurance 20 Alternative energy device deduction 21 Add lines 1 through 19 and 20e 22 Retirement benefits deduction 23 Nonresident military pay included in Form 43 line 28 Column A 24 Bonus depreciation Include computations 25 Other subtractions Include explanation 26 Total subtractions Column A add lines 21 22f 23 24 and 25 3 Bonus depreciation Include computation 4 Other additions Include explanation 5 Total additions Add lines 1 through 4 Enter here and on Form 43 line 29 A Additions See instructions page 25 B Subtractions See instructions page 26 C Credit for Income Tax Paid to Other States by Part Year Residents See instructions page 31 Check here if developmen tally disabled D Credit for Income Tax Paid to Other States by Idaho Residents on Active Military Duty See instructions page 32 Date of Birth of e Add lines 20a through 20d Can't exceed $5 000 E Credits for Contributions to Idaho Educational Entities Idaho Youth and Rehabilitation EFO00087 EFO00087p2 08 16 12 F Maintaining a Home for a Family Member Age 65 or Older or a Family Member With a Family Member For Form 43 Nonresident and Part Year Resident Returns Only Form 39NR 2012 G Dependents: (Continued from Form 43 page 1 Line 6c) IDAHO SUPPLEMENTAL SCHEDULE Include a copy of the income tax return and a separate Form 39NR 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 See instructions page 30 for qualified retirement benefits to be included on lines 22e and 22g Social Security Number Social Security Number This credit is being claimed for taxes paid to: (State name)