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Income Tax Supplemental Schedule
TC-40A
Pg. 1
40604
2016
SSN
Last name
USTC ORIGINAL FORM
Part 1 - Additions to Income (write the code and amount of each addition to income)
Code
Amount
.00
Code
Code
•
51 Lump sum distributions
57 Municipal bond interest
.00
53 Medical Savings Account (MSA) addback*
60 Untaxed income of a resident trust
•
54 Utah Educational Savings Plan (UESP) addback*
61 Untaxed income of a nonresident trust
.00
56 Child’s income excluded from parent’s return
69 Equitable adjustments
•
* to the extent previously deducted or credited on Utah return
.00
•
.00
•
.00
Total additions to income (add all additions to income and enter total here and on TC-40, line 5)
Part 2 - Subtractions from Income (write the code and amount of each subtraction from income)
Code
Amount
.00
Code
Code
•
71 Interest from U.S. Government Obligations
78 Railroad retirement income
.00
77 Native American Income:
Tribe
79 Equitable adjustments
•
Enrollment Number
Code
82 Nonresident active duty military pay
.00
Yours
•
85 State tax refund distributed to beneficiary
•
Spouse’s
•
88 Nonresident military spouse income
.00
•
.00
•
.00
Total subtractions from income (add all subtractions from income and enter total here and on TC-40, line 8)
Part 3 - Apportionable Nonrefundable Credits (write the code and amount of each credit)
Code
Amount
.00
Code
Code
•
04 Capital gain transactions credit
22 Medical Care Savings Account (MSA) credit
.00
18 Retirement tax credit (attach TC-40C)
23 Health benefit plan credit
•
20 Utah Educational Savings Plan (UESP) credit
24 Qualifying solar project credit
.00
26 Gold and silver coin sale credit
•
.00
•
.00
•
.00
Total apportionable nonrefundable credits (add all Part 3 credits and enter total here and on TC-40, line 24)
Part 4 - Nonapportionable Nonrefundable Credits (write the code and amount of each credit)
Code
Amount
.00
Code
Code
•
01 At-home parent credit
13 Carryforward of mach./equip. research credit
.00
02 Qualified sheltered workshop credit - name:
17 Tax paid to another state (attach TC-40S)
•
19 Live organ donation expenses credit
.00
05 Clean fuel vehicle credit
21 Renewable residential energy systems credit
•
06 Historic preservation credit
25 Combat related death credit
.00
07 Carryforward of enterprise zone credit
27 Veteran employment tax credit
•
08 Low-income housing credit
28 Employing persons who are homeless
.00
10 Recycling market dev. zone credit
63 Achieving a Better Life Experience Prog. credit
•
12 Research activities credit
.00
Total nonapportionable nonrefundable credits (add all Part 4 credits and enter total here and on TC-40, line 26)
Submit page ONLY if data entered.
Attach completed schedule to your Utah Income Tax Return.
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