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FORM 104PN
PART-YEAR RESIDENT/NONRESIDENT TAX CAlCulATION SCHEDulE 2009
Attach this form to your completed income tax return Form 104.
taxpayer’s name
social security number
use this form if you and/or your spouse were a resident of another state for all or part of 2009. this form
apportions your gross income so the Colorado tax computed from the tax table on your total 2009 income
will be reduced to reflect only the tax on your Colorado income. Complete this form after you have filled out
lines 1 through 14 of Form 104. If you filed federal form 1040NR, see
income 6.
1. Taxpayer is (check one):
Full-year nonresident;
Part-year resident from _____ /09 to _____ /09;
Full-year resident
2. Spouse is (check one):
Full-year nonresident;
Part-year resident from _____ /09 to _____ /09;
Full-year resident
3. Check the federal form you filed:
Federal
Colorado
1040
1040 EZ
other
Information
Information
1040a
1040 nr
4. Enter all income from Form 1040 line 7; 1040a line 7; or Form 1040EZ line1 ....... 4
.00
5. Enter income from line 4 that was earned while working in Colorado and/or earned
while you were a Colorado resident. Part-year residents should include moving
expense reimbursements only if paid for moving into Colorado. ....................................................... 5
.00
6. Enter all interest/dividend income from Form 1040 lines 8a and 9a; Form 1040a
.00
lines 8a and 9a; or Form 1040EZ line 2 .................................................................. 6
.00
7. Enter income from line 6 that was earned while you were a resident of Colorado ............................ 7
8. Enter all income from Form 1040 line 19; Form 1040a line 13; or Form 1040EZ
line 3 ....................................................................................................................... 8
.00
9. Enter income from line 8 that is from State of Colorado unemployment benefits;
and/or is from another state’s benefits that were received while you were a
Colorado resident. .............................................................................................................................. 9
.00
If you filed federal Form 1040EZ, go to line 24. All others continue with line 10.
10. Enter all income from Form 1040 lines 13 and 14; or Form 1040a line 10 ........... 10
.00
11. Enter income from line 10 that was earned during that part of the year you were a
Colorado resident and/or was earned on property located in Colorado. .......................................... 11
.00
12. Enter all income from Form 1040 lines 15b, 16b, and 20b; or Form 1040a lines 11b,
12b, and 14b ......................................................................................................... 12
.00
13. Enter income from line 12 that was received during that part of the year you were
a Colorado resident. ......................................................................................................................... 13
.00
If you filed federal Form 1040A, go to line 20. If you filed Form 1040, continue with line 14.
14. Enter all business and farm income from Form 1040 lines 12 and 18 .................. 14
.00
15. Enter income from line 14 that was earned during that part of the year you were a
Colorado resident and/or was earned from a Colorado operation. ................................................. 15
.00
16. Enter all schedule E income from Form 1040 line 17 ........................................... 16
.00
17. Enter income from line 16 that was earned from Colorado sources; and/or rent and
royalty income received or credited to your account during that part of the year you
were a Colorado resident; and/or partnership/S corporation/fiduciary income
apportioned based on the number of days of Colorado residency during the
.00
corporation/partnership/fiduciary tax year. ....................................................................................... 17
18. Enter all other income from Form 1040 lines 10, 11 and 21,
(list type _________________________________________________) ............ 18
.00
19. Enter income from line 18 that was earned or received during that part of the year
you were a Colorado resident and/or was received from Colorado sources ................................... 19
.00
(list type_________________________________________________)