Form 43 Idaho Part-Year Resident and Nonresident Income Tax Return

10 Alimony received 11 Business income or (loss) Include federal Schedule C or C EZ 12 Capital gain or (loss) If required include federal Schedule D 13 Other gains or (losses) Include federal Form 4797 14 IRA distributions (taxable amount) 15 Pensions and annuities (taxable amount) 16 Rents royalties partnerships S corporations trusts etc Include federal Schedule E 17 Farm income or (loss) Include federal Schedule F 18 Unemployment compensation 19 Other income Include explanation 20 TOTAL INCOME Add lines 7 through 19 21 Deductions for IRAs health savings accounts and IRC 501(c)(18)(D) retirement plan 22 Moving expenses alimony paid and student loan interest 23 Deductions for self employment tax health insurance and qualified retirement plans 24 Penalty on early withdrawal of savings 25 Other deductions See instructions 26 TOTAL ADJUSTMENTS Add lines 21 through 25 27 ADJUSTED GROSS INCOME Subtract line 26 from line 20 7 Wages salaries tips etc Include Form(s) W 2 8 Taxable interest income 9 Dividend income Check box if penalty is due to an ineligible withdrawal from an Idaho medical savings account Enter the total number here c I want to donate to: 53 Opportunity Scholarship Program if different than the Standard Deduction For Most People If you have an NOL and are electing to forgo the carryback period check here in 2012 line 4 in Column A Enter amount from line 27 in Column B Routing No To receive your grocery credit enter the computed amount on line 61 62 Maintaining a home for family member age 65 or older or developmentally disabled Include Form 39NR Yes No $11 900 $5 950 $8 700 {"6g } {"6i } 1 Single 2 Married filing joint return 3 Married filing separate return 4 Head of household 5 Qualifying widow(er) 28 Enter amount from federal Form 1040 line 37 1040A line 21 or 1040EZ 29 Additions from Form 39NR Part A line 5 Include Form 39NR 30 Subtractions from Form 39NR Part B line 26 Include Form 39NR 31 TOTAL ADJUSTED INCOME Add lines 28 and 29 less line 30 33 Itemized deductions Include federal Schedule A 34 All state and local income taxes included on federal Schedule A line 5 35 Subtract line 34 from line 33 36 Standard deduction See instructions page 14 to determine standard deduction amount 37 Multiply $3 800 by the number of exemptions claimed on line 6d 38 Add line 37 and the LARGER of line 35 or line 36 39 Idaho percentage Divide line 31 Column B by line 31 Column A 40 Multiply amount on line 38 by the percentage on line 39 and enter the result here 41 Idaho taxable income Subtract line 40 from line 31 Column B 42 TAX from tables or rate schedule See instructions page 36 43 Income tax paid to other states Include Form 39NR and other states returns 44 Total credits from Form 39NR Part E line 4 Include Form 39NR 45 Total business income tax credits from Form 44 Part I line 12 Include Form 44 46 Line 42 minus lines 43 through 45 If less than zero enter zero 47 Fuels tax due Include Form 75 48 Sales/Use tax due on Internet mail order and other nontaxed purchases 49 Total tax from recapture of income tax credits from Form 44 Part II line 7 Include Form 44 50 Tax from recapture of qualified investment exemption (QIE) Include Form 49ER 51 Permanent building fund Check the box if you are receiving Idaho public assistance payments 52 TOTAL TAX Add lines 46 through 51 54 Idaho Guard and Reserve Family 55 Idaho Children's Trust Fund 56 Special Olympics Idaho 57 Nongame Wildlife Conservation 58 American Red Cross of Greater Idaho 59 Idaho Foodbank 6 EXEMPTIONS 60 TOTAL TAX PLUS DONATIONS Add lines 52 through 59 60 61 Grocery credit See instructions page 16 Computed Amount (from worksheet) To donate your grocery credit to the Cooperative Welfare Fund check the box and enter zero on line 61 63 Special fuels tax refund Gasoline tax refund Include Form 75 64 Idaho income tax withheld Include Form(s) W 2 and any 1099(s) that show Idaho withholding 65 2012 Form 51 payment(s) and amount applied from 2011 return 66 Pass through income tax Withheld Paid by entity Include Form(s) ID K 1 67 Hire One Act credit for new employees Include Form 72 68 TOTAL PAYMENTS AND OTHER CREDITS Add lines 61 through 67 69 TAX DUE Subtract line 68 from line 60 70 Penalty Interest from the due date Enter total 71 TOTAL DUE Add lines 69 and 70 Make check or money order payable to the Idaho State Tax Commission 72 OVERPAID Line 68 minus lines 60 and 70 73 REFUND Amount of line 72 to be refunded to you 74 ESTIMATED TAX Amount of line 72 to be applied to your 2013 estimated tax 75 DIRECT DEPOSIT See instructions page 18 Check if final deposit destination is outside of the U S 76 Total due (line 71) or overpaid (line 72) 76 77 Refund from original return plus additional refunds 77 78 Tax paid with original return plus additional tax paid 78 79 Amended tax due or refund Add lines 76 and 77 less line 78 79 Account No Account: Address and phone number AMENDED AMENDED RETURN check the box and 6b if they apply b Check if blind c List your dependents If more than four dependents continue on Form 39NR Check if age 65 or older Check one for yourself and one for your spouse if a joint return Checking City State and Zip Code Column A Total Column B Idaho COPY OF YOUR d Total exemptions Add lines 6a through 6c Must match federal return d Daytime phone Deduction Do you need Idaho DONATIONS EFO00091 07 20 12 Enter "1" in boxes 6a FEDERAL RETURN FILING STATUS Check only one box First name Last name Social Security Number for amending and enter the number For calendar year 2012 or fiscal year beginning ending For Most Form 43 2012 EFO00091p2 07 20 12 Full months in Idaho this year Yourself Spouse Head of Household: IDAHO ADJUSTMENTS See instructions page 13 Idaho Amounts IDAHO INCOME See instructions page 13 IDAHO PART YEAR RESIDENT & NONRESIDENT INCOME TAX RETURN Idaho Resident on Active Military Duty If filing married joint or separate return enter spouse's name and Social Security Number above If someone can claim you as a dependent leave box 6a blank If you or your spouse are nonresident aliens for federal purposes check here If your parent or someone else can claim you as a dependent check here and enter zero on lines 37 and 61 INCLUDE A COMPLETE income tax forms Indicate current state of residence Yourself Spouse Jointly or Qualifying Widow(er): Last name MAIL TO: Idaho State Tax Commission PO Box 56 Boise ID 83756 0056 mailed to you next year? Mailing address Married filing Military Nonresident Must match federal return Nonresident OTHER TAXES Page 2 Paid preparer's signature Part Year Resident PAYMENTS People PLEASE PRINT OR TYPE Preparer's EIN SSN or PTIN REFUND Residency status Resident Savings See instructions page 12 for the reasons Single or Married filing Separately: Spouse Spouse Spouse b Spouse deceased Spouse's first name and initial Spouse's signature (if a joint return BOTH MUST SIGN) Spouse's Social Security Number (required) Standard State Use Only TAX DUE Taxpayer deceased Type of Under penalties of perjury I declare that to the best of my knowledge and belief this return is true correct and complete See instructions Within 180 days of receiving this return the Idaho State Tax Commission may discuss this return with the paid preparer identified below Your first name and initial Your signature Your Social Security Number (required) Yourself Yourself Yourself a