Form Ri-1040h-Rhode Island Property Tax Relief Claim - 2015 Page 2
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1
2State of Rhode Island and Providence Plantations
State of Rhode Island and Providence Plantations
2015 Form RI-1040H
2015 Form RI-1040H
15100299990102
Rhode Island Property Tax Relief Claim
Rhode Island Property Tax Relief Claim
Your name
Your name
Your social security number
Your social security number
PART 5
ENTER ALL INCOME RECEIVED BY YOU AND ALL OTHER PERSONS LIVING IN YOUR HOUSEHOLD
Enter the income amounts from your 2015 federal 1040 on the appropriate lines below. If you did not file a federal 1040, enter your income amounts on
.
the appropriate lines below
15
Wages, salaries, tips, etc. from Federal Form 1040, line 7 ................................................................................. 15
16
Interest and dividends (taxable and nontaxable) from Federal Form 1040, lines 8a, 8b and 9a .................
16
17
Taxable refunds, credits or offsets of state and local income taxes from Federal Form 1040, line 10 ........
17
18
Alimony received from Federal Form 1040, line 11 .....................................................................................
18
19
Business income (or loss) from Federal Form 1040 line 12 ........................................................................ 19
20
Sale or exchange of property from Federal Form 1040, lines 13 and 14..................................................... 20
IRA distributions, and pensions and annuities from Federal Form 1040, lines 15a and 16a ......................
21
21
22
Rental real estate, royalties, S corps, trusts, etc. from Federal Form 1040, line 17 ....................................
22
23
Farm income or loss from Federal Form 1040, line 18................................................................................
23
24
Unemployment compensation from Federal Form 1040, line 19.......................................................................
24
25
25
Social security benefits (including Medicare premiums) taxable and nontaxable, and Railroad
Retirement Benefits from Federal Form 1040, lines 20a .............................................................................
26
Other income from Federal Form 1040, line 21........................................................................................... 26
27
Total income from Federal 1040 - taxable and nontaxable. Add lines 15 through 26 .................................
27
28
28
Deductions from Federal Form 1040, line 36...............................................................................................
29
Adjusted income. Subtract line 28 from line 27..........................................................................................
29
30
Cash public assistance received. Enter here and on page 1, Part 2, line 1a.............................................
30
31
Other non-taxable income including child support, worker’s compensation and cash assistance from friends and family..
31
32
Addback of rental losses, etc. from lines 19, 20, 22, 23 or 26 above..........................................................
32
33
33
TOTAL 2015 HOUSEHOLD INCOME. Add lines 29, 30, 31 and 32. Enter here and on page 1, line 1b .......
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature
Spouse’s signature
Date
Telephone number
Paid preparer signature
Print name
Date
Telephone number
Paid preparer address
City, town or post office
State
ZIP code
PTIN
May the Division of Taxation contact your preparer? YES
Revised 07/2015
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