Form 1040n Draft - Nebraska Individual Income Tax Return

18 Amount from line 17 (Total Nebraska tax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19 Nebraska personal exemption credit for residents only ($130 per exemption) . . . . . 19

20 Credit for tax paid to another state, line 6, Nebraska Schedule II

(attach Nebraska Schedule II and the other state's return)

. . . . . . . . . . . . . . . . . . 20

21 Credit for the elderly or disabled (attach copy of Federal Schedule R) . . . . . . . . . . 21

22 Community Development Assistance Act credit (attach Form CDN) . . . . . . . . . . . . 22

23 Form 3800N nonrefundable credit (attach Form 3800N) . . . . . . . . . . . . . . . . . . . . . 23

24 Nebraska child/dependent care nonrefundable credit, only if line 5 is more

than $29,000 (attach a copy of Federal Form 2441 and see instructions) . . . . . . . . 24

25 Credit for financial institution tax (attach Form NFC) . . . . . . . . . . . . . . . . . . . . . . . . 25

26 Total nonrefundable credits (add lines 19 through 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

27 Subtract line 26 from line 18 (if line 26 is more than line 18, enter -0-) . If the result is greater than your

federal tax liability, complete the Federal Tax Liability Worksheet in the instructions . If entering federal tax,

and attach a copy of the federal return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

check box

28 Total Nebraska income tax withheld (attach 2015 Forms, see instructions)

a W-2 $ ________________

b K-1N $ ________________

c W-2G, 1099-R,1099-MISC, or others $ ________________ . . . . . . . . . . . . . . . . 28

29 2015 estimated tax payments (include any 2014 overpayment credited to 2015 and

any payments submitted with an extension request) . . . . . . . . . . . . . . . . . . . . . . . . 29

30 Form 3800N refundable credit (attach Form 3800N) . . . . . . . . . . . . . . . . . . . . . . . . 30

31 Nebraska child/dependent care refundable credit, if line 5 is $29,000 or less

(attach a copy of Form 2441N) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

32 Beginning Farmer credit (from Form 1099 BFC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

33 Nebraska earned income credit . Enter number of qualifying children

Federal credit

.00 x .10 (10%) (attach federal return,

pages 1 and 2 – see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

34 Angel Investment Tax Credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

35 Total refundable credits (add lines 28 through 34) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

36 Penalty for underpayment of estimated tax (see instructions) . If you calculated a Form 2210N penalty of -0-

. . . . . . . . 36

or greater, or used the annualized income method, attach Form 2210N, and check this box

37 Total tax and penalty. Add lines 27 and 36 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

38 Use tax due on taxable purchases where applicable sales tax was not collected . (see instructions)

Enter purchases subject to state tax

$__________ State tax

$___________ (purchases x 5 .5%);

Enter purchases subject to local tax

$__________ Local tax

$_______ (purchases x local rate of ____%)

Local code__ __ __(see local rate schedule);

Add state and local taxes and enter on line 38 . If no use tax is due, enter -0- on line 38 . . . . . . . . . . . . . . . . . . 38

39 Total amount due . If line 35 is less than total of lines 37 and 38, subtract line 35 from the total of lines 37

and 38 . Pay this amount in full . For electronic or credit card payment, check here

and see instructions . . . . 39

40 Overpayment. If line 35 is more than total of lines 37 and 38, subtract total of lines 37 and 38 from line 35 . . . 40

41 Amount of line 40 you want applied to your 2016 estimated tax . . . . . . . . . . . . . . .

42 Wildlife Conservation Fund donation of $1 or more . . . . . . . . . . . . . . . . . . .

43 Amount of line 40 you want refunded to you (line 40 minus lines 41 and 42) .

File early! It may take three months to receive your refund if you file a paper return

. . . . . . . . . . . . . . . . 43

Expecting a Refund? Have it sent directly to your bank account!

(see instructions)

44a Routing Number

44b Type of Account

1 = Checking

2 = Savings

(Enter 9 digits, first two digits must be 01 through 12, or 21 through 32;

use an actual check or savings account number, not a deposit slip)

44c Account Number

(Can be up to 17 characters . Omit hyphens, spaces, and special symbols . Enter from left to right and leave any unused boxes blank .)

44d

Check this box if this refund will go to a bank account outside the United States .

Under penalties of perjury, I declare that, as taxpayer or preparer, I have examined this return and to the best of my knowledge and belief, it is correct and complete .

sign

here

Your Signature

Date

Email Address

(

)

Keep a copy of

this return for

Spouse’s Signature (if filing jointly, both must sign)

Daytime Phone

your records .