Virginia Resident Form 760 - Individual Income Tax Return - 2011 Page 2

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Page 2
Your ssn
*VA0760211000*
Form 760
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2011
Year
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15. Amount of Tax from Tax Table or Tax Rate Schedule (round to whole dollars) ...........................15
16. Spouse Tax Adjustment. For Filing Status 2 only. Enter VAGI in whole dollars below. See instructions.
16a - Enter Your VAGI below
16b - Enter Spouse’s VAGI below
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loss
loss
16
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17. Net Amount of Tax - Subtract Line 16 from Line 15 ...............................................................17
18. Virginia tax withheld for 2011.
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18a. Your Virginia withholding ...................................................................................................18a
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18b. Spouse’s Virginia withholding (filing status 2 only) ...........................................................18b
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19. Estimated Tax Paid for tax year 2011 (from Form 760ES) ...........................................................19
(include overpayment credited from tax year 2010)
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20. Extension Payments (from Form 760IP) ......................................................................................20
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21. Tax Credit for Low Income Individuals or Earned Income Credit from attached Sch. ADJ, Line 17 .....21
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22. Credit for Tax Paid to Another State from attached Sch. OSC, Line 21 ......................................22
(You must attach Sch. OSC and a copy of all other state returns)
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23. Other Credits from attached Schedule CR ................................................................................23
(If claiming Political Contribution Credit only - fill in oval - see instructions)
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24. Add Lines 18a, 18b and 19 through 23 ....................................................................................24
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25. If Line 24 is less than Line 17, subtract Line 24 from Line 17. This is the Tax You Owe ............25
Skip to Line 28
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26. If Line 17 is less than Line 24, subtract Line 17 from Line 24. This is Your Tax Overpayment ...26
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27. Amount of overpayment you want credited to next year’s estimated tax ....................................27
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28. Adjustments and Voluntary Contributions from attached Schedule ADJ, Line 24 .......................28
(You must attach Schedule ADJ)
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29. Add Lines 27 and 28.....................................................................................................................29
30. If you owe tax on Line 25, add Lines 25 and 29. OR
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If Line 26 is less than Line 29, subtract Line 26 from Line 29. AMOUNT YOU OWE ................30
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CREDIT
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fill in oval if paying by credit or debit card
see instructions
CARD
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31. If Line 26 is greater than Line 29, subtract Line 29 from Line 26. YOUR REFUND ....................31
Checking
Savings
Account Type
Direct Deposit information
For domestic direct deposit
refunds only. See instructions.
Your bank routing transit number
Your bank account number
Qualifying farmer, fisherman or merchant seaman
Federal Schedule C filed with your federal return
Fill in all
ovals that
Earned Income Credit claimed on your federal return.
,
Overseas on due date
apply:
Amount claimed:
Primary Taxpayer Deceased
spouse Deceased
i (We), the undersigned, declare under penalty of law that i (we) have examined this return and to the best of my (our) knowledge, it is a true, correct and complete return.
Your Signature
Date
Spouse’s Signature
Date
Your business phone number
Home phone number
Spouse’s business phone number
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Filing
Preparer’s PTIN
Preparer’s Signature
Preparer’s Name, Address & Phone Number (please print)
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