Form N-11 - Individual Income Tax Return (Resident) - 2016

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STATE OF HAWAII — DEPARTMENT OF TAXATION
FORM
N-11
Individual Income Tax Return
(Rev. 2016)
RESIDENT
2016
Calendar Year
JBB161
OR
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M M
D D
Y Y
M M
D D
Y Y
AMENDED Return
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Fiscal Year
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NOL Carryback
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Beginning
and Ending
IRS Adjustment
FOR OFFICE USE ONLY
THIS
SPACE
Please Print In Black Ink.
Enter One Letter Or Number In Each Box.
Fill In Ovals Completely. Do NOT Submit a Photocopy!!
RESERVED
Fill in applicable oval, if appropriate
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First Time Filer
Address or Name Change
Your First Name
M.I.
Your Last Name
u IMPORTANT — Complete this Section u
Enter the first four letters
Spouse’s First Name
M.I.
Spouse’s Last Name
!!!!
of your last name.
Use ALL CAPITAL letters
Care Of (See Instructions, page 7.)
!!! !! !!!!
Your Social
Security Number
Present mailing or home address (Number and street, including Rural Route)
Enter the first four letters
!!!!
of your Spouse’s last name.
City, town or post office
State
Postal/ZIP code
Use ALL CAPITAL letters
!!! !! !!!!
Spouse's Social
If Foreign address, enter Province and/or State
Country
Security Number
(Fill in only ONE oval)
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1
Single
4
Head of household (with qualifying person). If the qualifying
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2
Married filing joint return (even if only one had income).
person is a child but not your dependent, enter the child’s full
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Married filing separate return. Enter spouse’s SSN and
3
name.
!
the first four letters of last name above. Enter spouse’s full
__________________________________
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name here. _____________________________________
5
Qualifying widow(er) with dependent child. Enter the year
!!!!
your spouse died
CAUTION: If you can be claimed as a dependent on another person’s tax return (such as your parents’), DO NOT fill in oval 6a, but be sure to fill in the oval above line 21.
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6a
Yourself ............................................
Age 65 or over ........................................................
Enter the number of ovals
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filled on 6a and 6b ..........
6b
Spouse.............................................
Age 65 or over ........................................................
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If you filled ovals 3 and 6b above, see the Instructions on page 9 and if your spouse meets the qualifications, fill in this oval
6c
!!
Dependents:
If more than 4 dependents
2. Dependent’s social
Enter number of
1. First and last name
use attachment
security number
3. Relationship
ç
and
your children listed ... 6c
6d
!!
Enter number of
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other dependents ......6d
!!
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6e
Total number of exemptions claimed. Add numbers entered in boxes 6a thru 6d above...............................................
6e
FORM N-11

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