Form 200-02 Draft - Delaware Individual Non-Resident Incometax Return - 2012
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DELAWARE INDIVIDUAL
DO NOT WRITE OR STAPLE IN THIS AREA
2012
NON-RESIDENT
INCOME TAX RETURN
FORM 200-02
or Fiscal year beginning
and ending
Your Social Security No.
Spouse’s Social Security No.
(Attach Label Here) DO NOT COVER SOCIAL SECURITY NUMBERS
Your Last Name
First Name and Middle Initial
Jr., Sr., III., etc.
Spouse’s Last Name
Spouse’s First Name
Jr., Sr., III., etc.
Present Home Address (Number and Street)
Apt. #
City
State
Zip Code
FILING STATUS (MUST CHECK ONE)
If you were a part-year resident in 2012, give the dates you
Check if FULL-YEAR
resided in Delaware.
Married or Entered into a Civil Union
non-resident in 2012
1.
Single, Divorced, Widow(er)
3.
& Filing Separate Forms
From
2012
To
2012
Form DE2210 Attached
2.
Joint or Entered into a Civil Union
5.
Head of Household
Month
Day
Month
Day
00
37.
DELAWARE ADJUSTED GROSS INCOME (Enter amount from reverse side, Line 30B, Column 1)
......................
37
38.
(a) If you elect the STANDARD DEDUCTION check here.........................................................................................
a.
$3250
$6500
Filing Statuses 1, 3 & 5 -
Filing Status 2 -
00
38
(b) If you elect to ITEMIZE DEDUCTIONS check here and enter amount from reverse side Line 36.............................. b.
ADDITIONAL STANDARD DEDUCTIONS
(
39.
Not Allowed with Itemized Deductions - see instructions)
CHECK BOX(ES)
00
39
If SPOUSE was 65 or over
and/or Blind
If YOU were 65 or over
and/or Blind
TOTAL DEDUCTIONS - Add Lines 38 & 39 and enter here
40
00
40.
..............................................................................................
TAXABLE INCOME - Subtract Line 40 from Line 37, and Compute Tax on this Amount
41
41.
00
............................................
Tax Liability Computation
42.
Tax Liability from Tax Rate
Proration Decimal
Table/Schedule
A
00
Line 30 A
(See instructions, page 10)
Amount
B
Line 30 B
00 =
.
x
00
00
42
PERSONAL CREDITS
(If Filing Status 3, see instructions on page 10)
4 3 a
Enter number of exemptions claimed on Federal return
X $110. =
00
43a
Multiply this amount by the proration decimal on Line 42 (X
) and enter total here
................
43b
CHECK BOX(ES)
Spouse 60 or Over (if filing status 2)
Self 60 or Over
Enter number of boxes checked on Line 43b
X $110. =
00
43b
Multiply this amount by the proration decimal on Line 42 (X
) and enter total here.......................... ............
44.
Tax imposed by State of
(Must attach copy of DE Sch. I and other state return)
00
44
44
(Part-Year Residents Only. See instructions, page
11)................................................
00
45
45
45.
Other Non-Refundable Credits (See instructions, page 11)..................................................
46
46.
00
Total Non-Refundable Credits. Add Lines 43a, 43b, 44 and 45.................................................................................................
47
00
47
.
BALANCE. Subtract Line 46 from Line 42. If Line 46 is greater than Line 42, enter “0” (Zero)................................................
00
48.
Delaware Tax Withheld
(Attach
W-2s/1099s)......................................................................
48
48
49.
2012 Estimated Tax Paid & Payments with Extensions...........................................................
00
49
49
50.
00
S Corp Payments and Refundable Business Credits (See Instructions, Page 12).................
50
50
00
51
51
51.
2012 Capital Gains Tax Payments
(Attach Form
5403)............................................................
00
52.
T
O
T
A
L
R
E
F
U
N
D
A
B
L
E
C
R
E
D
T I
. S
A
d
d
L
n i
s e
4
, 8
4
, 9
5
, 0
a
n
d
5
1
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52
00
00
53.
53
If Line 47 is greater than Line 52, subtract 52 from 47 and enter here.....................................................AMOUNT YOU OWE >
00
54.
54
If Line 52 is greater than Line 47, subtract 47 from 52 and enter here...........................................................OVERPAYMENT >
55.
CONTRIBUTIONS TO SPECIAL FUNDS
TOTAL >
00
If electing a contribution, complete and attach DE Schedule III..............................................................................................................
55
00
56.
56
AMOUNT OF LINE 54 TO BE APPLIED TO 2013 ESTIMATED TAX ACCOUNT.................................................................................. ENTER
>
00
57
57.
PENALTIES AND INTEREST DUE. If Line 53 is greater than $400, see estimated tax instructions...................................................ENTER
>
00
58
58.
NET BALANCE DUE. Enter the amount due (Line 53 plus Lines 55 and 57) and pay in full..................................................... PAY IN FULL
>
00
59
59.
NET REFUND. Subtract Lines 55, 56 and 57 from Line 54............................................................................ . ZERO DUE/TO BE REFUNDED
>
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and believe it is true, correct and complete.
Your Signature
Date
Signature of Paid Preparer
Date
EIN,SSN or PTIN
X
X
Spouse’s Signature (If filing joint)
Date
Address
Zip Code
X
Home Phone
Business Phone
Business Phone
*DE20312019999*
Email Address
Email Address
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