Form
North Dakota Office of State Tax Commissioner
ND-1 Individual income tax return
2011
WEB
If a fiscal year filer, enter
/
/
Please type or print in black or blue ink.
fiscal year end: (See page 11)
Your name (First, MI, Last name)
Your social security number*
Deceased
Spouse's social security number*
If joint return, spouse's name (First, MI, Last name)
Deceased
Mailing address
Apt No.
Fill in only if applicable: (See page 11)
Amended return: General
State
Zip code
City
Amended return: Federal NOL
Extension
A.
1. Single
Were you required to pay
Filing status used
4. Head of household
Yes
estimated federal income tax
on federal return:
2. Married filing jointly
5. Qualifying widow(er) with
No
for 2011? (See page 11)
(Fill in only one)
3. Married filing separately
dependent child
C.
B.
Income source code:
School district code:
MN/MT Reciprocity
(See page 11)
(See page 19)
(See page 11)
State
D. Federal adjusted gross income
from line 37 of Form 1040, line 21 of Form 1040A,
(SX) D
or line 4 of Form 1040EZ
1. Federal taxable income
from line 43 of Form 1040, line 27 of Form 1040A,
or line 6 of Form 1040EZ (If zero, see page 12 of instructions)
(SS) 1
Additions
2.
(NA) 2
Lump-sum distribution from Federal Form 4972
3.
Loss from passthrough entity subject to North Dakota's
(NB) 3
financial institution tax
4. a.
(NK) 4a
Planned gift or endowment tax credit adjustment to income
b.
(AP) 4b
Housing incentive fund tax credit adjustment to income
5.
5
Total additions. Add lines 2 through 4b
6.
6
Add lines 1 and 5
Subtractions
7.
(SN) 7
Interest from U.S. obligations
8.
Net long-term capital gain exclusion
(NC) 8
(From worksheet on page 13 of instructions)
9.
(S4) 9
Exempt income of an eligible Native American
10.
Benefits received from U.S. Railroad Retirement Board
(S5) 10
11.
Income from passthrough entity subject to North Dakota's
(S6) 11
financial institution tax
12.
National Guard/Reserve member federal active duty pay exclusion
(NI) 12
(Attach copy of Title 10 orders)
13.
Nonresident only: Servicemembers Civil Relief Act adjustment
(Attach copy of Form W-2 showing this compensation)
(NJ) 13
14.
College SAVE account deduction
(AA) 14
15.
(AO) 15
Qualified dividend exclusion
16.
(AB) 16
Total other subtractions (Attach Schedule ND-1SA)
17.
Total subtractions. Add lines 7 through 16
17
18. North Dakota taxable income.
If less than zero, enter 0
Subtract line 17 from line 6.
(ND) 18