Form It-360.1 - 2011 Change Of City Resident Status

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IT-360.1
New York State Department of Taxation and Finance
Change of City Resident Status
New York City • Yonkers
Attach this form to Form IT-201 or Form IT-203.
Social security number
Name(s) as shown on return
Change of resident status — If you are married and filing separate New York State returns, each of you must complete a
separate Form IT-360.1
.
( see instructions, Form IT-360.1-I, front page )
Mark an X in only one box (A)
New York City change of residence — Complete Parts 1, 2, 3, and 4.
(B)
Yonkers change of residence — Complete Parts 1 and 5.
(C)
New York City and Yonkers change of residence — Complete the entire form.
Column A
Column B
Column C
Part 1 — New York adjusted gross
Federal income
Amount of Column A
Amount of Column A
income
and adjustments
for New York City
for Yonkers
(see instructions, page 3)
resident period
resident period
( all sources )
1 Wages, salaries, tips, etc . ......................
1.
2 Taxable interest income .........................
2.
3 Ordinary dividends ................................
3.
4 Taxable refunds, credits, or offsets of
state and local income taxes .............
4.
5 Alimony received ...................................
5.
6 Business income or loss
( attach copy of
...
6.
federal Schedule C or C-EZ, Form 1040 )
7 Capital gain or loss
( attach copy of federal
7.
........................
Schedule D, Form 1040 )
8 Other gains or losses
( attach copy of
................................
8.
federal Form 4797 )
9 Taxable amount of IRA distributions .....
9.
10 Taxable amount of pensions and annuities 10.
11 Rental real estate, royalties,
partnerships, S corporations, trusts, etc.
11.
( attach copy of federal Schedule E, Form 1040 )
12 Farm income or loss
( attach copy of
............... 12.
federal Schedule F, Form 1040 )
13 Unemployment compensation .............. 13.
14 Taxable amount of social security benefits 14.
15 Other income .........................................
Identify:
15.
16 Total
.................... 16.
( add lines 1 through 15 )
17 Total federal adjustments to income .....
Identify:
17.
18 Federal adjusted gross income
................. 18.
( subtract line 17 from line 16 )
19 New York adjustments
19.
( attach schedule )
20 New York adjusted gross income
( line 18 and add or subtract line 19;
transfer the amount from Column B to
................................................. 20.
line 43 )
3601110094
Please file this original scannable form with the Tax Department.

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