Form N-11 - Individual Income Tax Return (Resident) - 2016 Page 3
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4Form N-11 (Rev. 2016)
Page 3 of 4
Your Social Security Number
Your Spouse’s SSN
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JBB163
Name(s) as shown on return ___________________________________________________
25
Multiply $1,144 by the total number of exemptions claimed on line 6e.
If you and/or your spouse are blind, deaf, or disabled, fill in the applicable oval(s),
and see page 23 of the Instructions.
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Spouse ............................................................................................... 25
Yourself
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26
Taxable Income. Line 24 minus line 25 (but not less than zero) ...................Taxable Income ä 26
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27
Tax. Fill in oval if from
Tax Table;
Tax Rate Schedule; or
Capital Gains Tax
Worksheet on page 39 of the Instructions.
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Fill in oval if tax from Forms N-2, N-103, N-152, N-168, N-312, N-338,
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N-344, N-348, N-405, N-586, N-615, or N-814 is included.) .............................................. Tax ä 27
27a
If tax is from the Capital Gains Tax Worksheet, enter
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the net capital gain from line 14 of that worksheet .......... 27a
28
Refundable Food/Excise Tax Credit
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(attach Form N-311) DHS, etc. exemptions
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29
Credit for Low-Income Household
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Renters (attach Schedule X) ............................................. 29
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Credit for Child and Dependent
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Care Expenses (attach Schedule X) ................................. 30
31
Credit for Child Passenger Restraint
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System(s) (attach a copy of the invoice)............................ 31
32
Total refundable tax credits from
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Schedule CR (attach Schedule CR) .................................. 32
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Add lines 28 through 32 ................................................................. Total Refundable Credits ä 33
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Line 27 minus line 33. If line 34 is zero or less, see Instructions. .................................................. 34
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Total nonrefundable tax credits (attach Schedule CR) .................................................................. 35
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Line 34 minus line 35 ................................................................................................. Balance ä 36
37
Hawaii State Income tax withheld (attach W-2s)
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(see page 28 of the Instructions for other attachments) .................. 37
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38
2016 estimated tax payments............................................ 38
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39
Amount of estimated tax applied from 2015 return ........... 39
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Amount paid with extension............................................... 40
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41
Add lines 37 through 40 ................................................................................. Total Payments ä 41
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42
If line 41 is larger than line 36, enter the amount OVERPAID (line 41 minus line 36) (see Instructions) .. 42
43
Contributions to (see page 29 of the Instructions): ........................
Yourself
Spouse
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43a Hawaii Schools Repairs and Maintenance Fund .....................
$2
$2
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43b Hawaii Public Libraries Fund ...................................................
$2
$2
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43c Domestic and Sexual Violence / Child Abuse and Neglect Funds .............
$5
$5
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44
Add the amounts of the filled ovals on lines 43a through 43c and enter the total here ................. 44
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45 Line 42 minus line 44 ........................................................................................................ 45
FORM N-11
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