Form Mo-Nri - Missouri Income Percentage - 2002
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1
2Attachment Sequence No. 1040-04 and 1040C-02
2002
MISSOURI DEPARTMENT OF REVENUE
FORM
MISSOURI INCOME
MO-NRI
PERCENTAGE
A COPY OF YOUR FEDERAL RETURN MUST BE ATTACHED.
• If your home of record is Missouri or you had Missouri source income, complete this form only after Form MO-1040, Lines 1 through 25, or Form MO-1040C, Lines 1
through 14 are completed.
• If you filed a joint federal return, you must file a combined Missouri return (even if only one of you had Missouri income) and complete each column below. Do not
combine Missouri source income for yourself and your spouse.
• Military pay of a nonresident stationed in Missouri should not be included in Missouri source income.
• If you are a nonresident stationed in Missouri or you moved into Missouri after December 31, 2002, and neither you nor your spouse had Missouri source income, check this
box
and complete Part A and Part B below. You are not required to file a Missouri return. Sign Form MO-NRI on reverse side and send Form MO-NRI along with all
Form W-2(s) to: Missouri Department of Revenue, P.O. Box 3900, Jefferson City, MO 65105-3900. Military personnel must attach a Leave and Earnings Statement.
PART A — CHECK YOUR STATUS ON EITHER LINE 1, LINE 2, OR LINE 3 BELOW.
NAME (YOURSELF)
NAME (SPOUSE)
ADDRESS
ADDRESS
CITY, STATE, ZIP CODE
SOCIAL SECURITY NUMBER
CITY, STATE, ZIP CODE
SOCIAL SECURITY NUMBER
1. NONRESIDENT OF MISSOURI
1. NONRESIDENT OF MISSOURI
WHAT WAS YOUR STATE OF RESIDENCE DURING 2002?
WHAT WAS YOUR STATE OF RESIDENCE DURING 2002?
2. PART-YEAR MISSOURI RESIDENT
2. PART-YEAR MISSOURI RESIDENT
a. INDICATE THE DATE YOU WERE A
DATE FROM:
DATE TO:
a. INDICATE THE DATE YOU WERE A
DATE FROM:
DATE TO:
MISSOURI RESIDENT IN 2002.
MISSOURI RESIDENT IN 2002.
b. INDICATE YOUR OTHER STATE OF
DATE FROM:
DATE TO:
b. INDICATE YOUR OTHER STATE OF
DATE FROM:
DATE TO:
RESIDENCE AND THE DATE YOU
RESIDENCE AND THE DATE YOU
RESIDED THERE.
RESIDED THERE.
3. MILITARY/NONRESIDENT TAX STATUS — Indicate your tax status
3. MILITARY/NONRESIDENT TAX STATUS — Indicate your tax status
below and complete Part B—Missouri Income Percentage.
below and complete Part B—Missouri Income Percentage.
a. Missouri Domicile
a. Missouri Domicile
I did not at any time during the 2002 tax year maintain a permanent place of
I did not at any time during the 2002 tax year maintain a permanent place of
abode in Missouri nor did I spend more than 30 days in Missouri during the
abode in Missouri nor did I spend more than 30 days in Missouri during the
year. I did maintain a permanent place of abode in the state of __________
year. I did maintain a permanent place of abode in the state of __________
_______________________________________________.
_______________________________________________.
b. Non-Missouri Domicile
b. Non-Missouri Domicile
I resided in Missouri during 2002 solely because I was stationed at _______
I resided in Missouri during 2002 solely because I was stationed at _______
______________________________ on military orders, my home of record
______________________________ on military orders, my home of record
is in the state of ________________________________.
is in the state of ________________________________.
If you qualified as a nonresident and you had no Missouri source income,
If you qualified as a nonresident and you had no Missouri source income,
enter 0% on Form MO-NRI, Part B, Line 3 below, and on Form MO-1040, Line
enter 0% on Form MO-NRI, Part B, Line 3 below, and on Form MO-1040, Line
27S, or Form MO-1040C, Line 16. If you have wages in Missouri (other than
27Y, or Form MO-1040C, Line 16. If you have wages in Missouri (other than
military pay), you must complete Part B and include your Missouri wages on
military pay), you must complete Part B and include your Missouri wages on
Line 1. If you are a military nonresident stationed in Missouri and neither you
Line 1. If you are a military nonresident stationed in Missouri and neither you
nor your spouse had Missouri source income, enter “0” on Part B, Line 1
nor your spouse had Missouri source income, enter “0” on Part B, Line 1
below and enter your federal adjusted gross income on Part B, Line 2.
below and enter your federal adjusted gross income on Part B, Line 2.
PART B — MISSOURI INCOME PERCENTAGE
Complete ONLY PART B, if income consists of only wages or salaries with no adjustments on Federal Form 1040A,
Line 20, or Federal Form 1040, Line 34. Otherwise, complete Part C and then complete Part B.
YOURSELF OR
SPOUSE (ON A
ONE INCOME FILER
COMBINED RETURN)
00
00
1. Missouri income — Enter wages, salaries, etc. from Missouri. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2. Taxpayer’s total adjusted gross income (from Form MO-1040, Lines 5Y and 5S; Form MO-1040C,
Line 3; or from your federal form if you are a military nonresident and you are not
00
00
required to file a Missouri return). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3. MISSOURI INCOME PERCENTAGE (divide Line 1 by Line 2). If greater than 100%, enter 100%.
(Round to a whole percent such as 91% instead of 90.5% and 90% instead of 90.4%. However, if
percentage is less than 0.5%, use the exact percentage.) Enter percentage here and on
Form MO-1040, Lines 27Y and 27S, or Form MO-1040C, Line 16. . . . . . . . . . . . . . . . . . . . . . . . . .
%
3
%
This form is available upon request in alternative accessible format(s).
MO 860-1096 (11-2002)
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