Form 200-01 - Delaware Individual Resident Income Tax Return Page 2

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R
2016
Page 2
2016 DELAWARE RESIDENT FORM 200-01, PAGE 2
COLUMNS: Column A is reserved for the spouse of those couples choosing filing status 4. (Reconcile your Federal
totals to the appropriate individual. See Page 9 worksheet.) Taxpayers using filing statuses 1, 2, 3, or 5 are to complete Column B only.
Filing Status 4 ONLY
All other filing statuses
Spouse Information
You or You plus Spouse
MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME
COLUMN A
COLUMN B
SECTION A - ADDITIONS (+)
Enter Federal AGI amount from Federal 1040, 1040A or 1040EZ ..............................................................................
29.
29
Interest on State & Local obligations other than Delaware .........................................................................................
30.
30
31.
Fiduciary adjustment, oil depletion .............................................................................................................................
31
32.
TOTAL - Add Lines 30 and 31 ....................................................................................................................................
32
Subtotal. Add Lines 29 and 32 ...........................................
33.
33
SECTION B - SUBTRACTIONS (-)
34.
Interest received on U.S. Obligations .........................................................................................................................
34
Pension/Retirement Exclusions
............
35.
35
(For a definition of eligible income, see instructions on Page 10)
Delaware State tax refund, fiduciary adjustment, work opportunity tax credit, Delaware NOL carry forward -
36.
please see instructions on Page 10 ............................................................................................................................
36
Taxable Soc Sec/RR Retirement Benefits/Higher Educ. Excl/Certain Lump Sum Dist. (See instr. on Page 11) ........
37.
37
SUBTOTAL. Add Lines 34, 35, 36 and 37, and enter here ........................................................................................
38.
38
Subtotal. Subtract Line 38 from Line 33 ............................
39
39.
40.
Exclusion for certain persons 60 and over or disabled (See instructions on Page 11) ...............................................
40
TOTAL - Add Lines 38 and 40 .....................................................................................................................................
41.
41
DELAWARE ADJUSTED GROSS INCOME. Subtract line 41 from Line 33. Enter here and on Front, Line 1 ...........
42.
42
SECTION C - ITEMIZED DEDUCTIONS (MUST ATTACH FEDERAL SCHEDULE A) If columns A and B are used and you are unable to specifically
allocate deductions between spouses, you must prorate in accordance with income.
43
43.
Enter total Itemized Deduction from Schedule A, Federal Form, Line 29 ...................................................................
44.
Enter Foreign Taxes Paid (See instructions on Page 11) ...........................................................................................
44
45.
Enter Charitable Mileage Deduction (See instructions on Page 11) ...........................................................................
45
SUBTOTAL - Add Lines 43, 44, and 45 and enter here ..............................................................................................
46.
46
Enter State Income Tax included in Line 43 above (See instructions on Page 11) .....................................................
47a.
47a
Enter Form 700 Tax Credit Adjustment (See instructions on Page 11) .......................................................................
47b.
47b
TOTAL - Subtract Line 47a and 47b from Line 46. Enter here and on Front, Line 2 (See instructions) ......................
48.
48
SECTION D - DIRECT DEPOSIT INFORMATION If you would like your refund deposited directly to your
checking or savings account, complete boxes a, b, c and d below. See instructions for details.
a. Routing Number
b. Type:
Checking
Savings
c. Account Number
d. Is this refund going to or through an account that
is located outside of the United States?
Yes
No
NOTE: If your refund is adjusted by $100.00 or more, a paper check will be issued and mailed to the address on your return.
BE SURE TO SIGN YOUR RETURN BELOW AND KEEP A COPY FOR YOUR RECORDS
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
Spouse’s Signature (if filing joint or combined return)
Date
Address
Home Phone
Business Phone
City
State
Zip
E-Mail Address
EIN, SSN or PTIN
Business Phone
E-Mail Address
BALANCE DUE W/PAYMENT ENCLOSED (LINE 27)
REFUND (LINE 28):
ALL OTHER RETURNS:
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
P.O. BOX 508
P.O. BOX 8710
P.O. BOX 8711
WILMINGTON, DE 19899-0508
WILMINGTON, DE 19899-8710
WILMINGTON, DE 19899-8711
MAKE CHECK PAYABLE TO: DELAWARE DIVISION OF REVENUE
PLEASE REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN
*DF20116029999*
(Rev 11/2016)
DF20116029999

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