1 Ordinary business income (loss) 1
10 Other deductions and losses 10
11 Qualified U S government interest deduction 11
12 State and local bond interest and dividend income 12
13 Community Development Assistance Act credit 13
14 Form 3800N credit 14
15 Angel investment tax credit 15
16 Nebraska income tax withheld (see instructions) 16
2 Net income (loss) from rental real estate activities 2
3 Net income (loss) from other rental activities 3
4 Interest income 4
5 Dividend income 5
6 Net short term capital gain (loss) 6
7 Net long term capital gain (loss) 7
8 Other income 8
9 Estate tax 9
Beginning 2013 and Ending 20
Final Amended
If applicable check the appropriate box: Check One:
Other (describe)
Resident Individual Nonresident Individual Estate or Trust
8 693 2013
BENEFICIARY S NAME AND MAILING ADDRESS
Beneficiary s Share of Credits
Beneficiary s Share of Income and Deductions
Beneficiary s Share of Income Deductions Modifications and Credits
Beneficiary s Share of Modifications
City State Zip Code City State Zip Code
ESTATE S OR TRUST S NAME AND MAILING ADDRESS
Form 1041N
Legal Name
Name Doing Business As (dba) Name
Nebraska ID Number Federal ID Number Nebraska ID Number Federal ID Number
Nebraska Schedule K 1N
Part A
Part B
Part C
revenue nebraska gov 800 742 7474 (NE and IA) 402 471 5729
Schedule K 1N
Street or Other Mailing Address Street or Other Mailing Address
Taxable Year of Organization Social Security Number Spouse s Social Security Number
