Personal Income Tax Forms And Instructions Resident & Nonresident/part-Year Resident

INSTRUCTIONS FOR NONRESIDENT/PART-YEAR RESIDENT SCHEDULE M

Line 55. LUMP SUM PENSION DISTRIBU-

Complete Schedule M to report increasing or de-

tirement income received from these sources,

creasing modifications to the federal adjusted

TIONS. Enter the amount of any qualifying

including any survivorship annuities, which is

402(e) lump sum distributions not included in

gross income. This schedule is not required if

included in your federal adjusted gross income

you report a modification other than those listed

your federal adjusted gross income that was

Line 61. WEST VIRGINIA TEACHERS RETIRE-

separately reported and taxed on federal

on lines 68 or 69 and can be clearly described in

MENT, WEST VIRGINIA PUBLIC EMPLOYEES

Form 4972.

the space provided on lines 3 and 4.

RETIREMENT, MILITARY RETIREMENT AND

Line 56. OTHER INCOME EXCLUDED FROM

IMPORTANT - These definitions apply to the

FEDERAL RETIREMENT. (MAXIMUM DEDUC-

modifications on lines 68 and 69:

FEDERAL ADJUSTED GROSS INCOME BUT

TION $2,000). Regardless of your age, enter

SUBJECT TO STATE TAX. West Virginia in-

the taxable amount of retirement income (not to

PERMANENTLY AND TOTALLY DISABLED.

come tax is based on federal adjusted gross in-

exceed $2,000) reported on your federal return

An individual (regardless of age) is permanently

come determined by existing law at the begin-

which was received from (A) The West Virginia

and totally disabled if he/she is unable to en-

ning of the taxable year. If Congress changes

Teachers Retirement System, (B) The West Vir-

gage in any substantial gainful activity by rea-

federal tax law to exclude certain income

ginia Public Employees Retirement System, (C)

son of any medically determinable physical or

from 2005 federal adjusted gross income

Military Retirement and (D) Federal Retirement.

mental impairment which can be expected to re-

after December 31, 2004 enter the amount

Do not enter more than $2,000.

sult in death or which has lasted or can be ex-

of that income on line 56 of Schedule M (for

pected to last for a continuous period of not less

Line 62. MILITARY RETIREMENT MODIFICA-

example; income deducted under Sec-

than 12 months.

TION. There is an additional modification for a

tion 199 of the Internal Revenue Code).

maximum of $20,000. If your pension is equal

SURVIVING SPOUSE. A taxpayer whose

Attach Schedule K-1(s).

to or greater than $22,000, enter $20,000 here.

spouse died during the year prior to the taxable

Line 57. WITHDRAWALS FROM A MEDICAL

If the pension is less than $22,000, enter $20,000

year for which the annual return is being filed

SAVINGS ACCOUNT OR PREPAID TUITION

or the total amount of the pension received less

and who has not remarried at any time before

CONTRACT/PLAN NOT USED FOR PAYMENT

the $2,000 claimed on line 61. In no case should

the end of the year for which the annual return is

OF QUALIFYING EXPENSES. Enter the

the combined amount (line 61 and line 62) ex-

being filed.

amount of any withdrawal you made from a quali-

ceed the total amount of military retirement in-

If you claim a modification on line 68 for being

fied medical savings account or prepaid tuition

come.

permanently and totally disabled during 2005 OR

contract/plan which was spent for OTHER than

Line 63. PENSION BENEFIT GUARANTY

on line 69 as the surviving spouse of a taxpayer

qualifying expenses.

MODIFICATION. If you retired under an em-

who was permanently and totally disabled prior

Any amount entered on this line may also be

ployer-provided defined benefit plan that termi-

to his/her death, you MUST attach a 2005 West

subject to a twenty percent (20%) surtax (Sched-

nated prior to or after retirement and the pen-

Virginia Schedule H. A copy of federal

ule T, page 22).

sion plan is covered by a guarantor whose maxi-

Schedule R or a previously filed West Virginia

mum benefit guarantee is less than the maxi-

Line 58. TOTAL ADDITIONS. Add lines 52

Schedule H may be substituted for the 2005

mum benefit to which you were entitled, you may

Schedule H.

through 57. Enter the result here and on line 3

be allowed a reducing modification of the differ-

of Form IT-140NR/PY.

If you are disabled AND OVER 65, you are not

ence between the amount you would have re-

required to complete Schedule H. Enter year

Modifications Decreasing Federal Adjusted

ceived had the plan not terminated and the

Gross Income (subtractions to income).

of birth on the front of Form IT-140NR/PY.

amount actually received from the guarantor.

If you claim a modification other than those

NOTE:

COMPLETE THIS SECTION OF

Attach a completed Schedule PBGC (page 20)

SCHEDULE M LINE-BY-LINE. If filing a joint

shown on Schedule M, it must be explained

and a copy of 1099R provided by the guaran-

on line 3 or 4 of your return.

return, enter the modification(s) for both you and

tor. Failure to do so will delay the processing of

your spouse in Columns A and B. In cases of

Modifications Increasing Federal Adjusted

your return.

joint ownership of income-producing tangible or

Gross Income (additions to income).

intangible property, each spouse should use the

Line 64. INCOME INCLUDIBLE IN FEDERAL

Line 52. INTEREST OR DIVIDEND INCOME ON

total income multiplied by the relative percent-

ADJUSTED GROSS INCOME BUT EXEMPT

FEDERAL OBLIGATIONS. Enter the amount of

age of ownership.

FROM STATE TAX BY FEDERAL LAW. Enter

any interest or dividend income (received by or

Line 59. INTEREST OR DIVIDENDS ON

the amount(s) of income received from the United

credited to you during the taxable year) on bonds

UNITED STATES OBLIGATIONS. Enter the

States Railroad Retirement Board including un-

or securities of any United States authority, com-

total amount of interest or dividend income on

employment compensation, disability and sick

mission or instrumentality which the laws of the

obligations of the United States and its posses-

pay which is included in your federal adjusted

United States exempt from federal income tax

sions, bonds or securities from any United States

gross income. Enclose form 1099RRB to sup-

but not from state income tax.

authority, commission, or instrumentality to the

port modification. West Virginia does not im-

Line 53. INTEREST OR DIVIDEND INCOME

extent includible in your federal adjusted gross

pose tax on this income.

ON STATE AND LOCAL BONDS (OTHER

income but exempt from state income tax under

Social Security benefits taxable on your federal

THAN WEST VIRGINIA). Enter the amount of

federal law. This will include United States Sav-

return are also taxable to West Virginia and

any interest or dividend income on state and lo-

ings Bonds and federal interest dividends paid

should NOT be included on this line.

cal bonds (other than West Virginia and its po-

to shareholders of a regulated investment com-

litical subdivisions) received by or credited to you.

Line 65. REFUNDS OF STATE AND LOCAL

pany under Section 852 of the IRS Code. Also

INCOME TAXES. Enter the amount reported

include on this line interest earned on West Vir-

Line 54. INTEREST ON MONEY BORROWED

on your federal return. Only refunds included in

ginia bonds which are subject to federal tax but

TO PURCHASE BONDS EARNING EXEMPT

your federal adjusted gross income are subject

exempt from state tax under West Virginia law.

WEST VIRGINIA INCOME. Enter the amount

to this modification.

of any interest deducted, as a business expense

Line 60. ANY WEST VIRGINIA STATE OR LO-

or otherwise, from your federal adjusted gross

Line 66. CONTRIBUTIONS TO THE WEST VIR-

CAL POLICE, DEPUTY SHERIFF’S OR

income, in connection with money borrowed to

GINIA PREPAID TUITION TRUST/WEST VIR-

FIREMEN’S RETIREMENT. Enter the taxable

purchase or carry bonds or securities, the income

GINIA SAVINGS PLAN TRUST. Enter here pay-

amount of retirement income reported on your

from which is exempt from West Virginia income

ments paid to prepaid tuition trust fund/savings

federal return which was received from any West

tax.

plan trust, but only to the extent the amount is

Virginia state or local police, deputy sheriff’s or

not already allowable as a deduction when arriv-

firemen’s retirement system, REGARDLESS OF

ing at your federal adjusted gross income.

YOUR AGE. This is the taxable amount of re-

Personal Income Tax Forms And Instructions Resident & Nonresident/part-Year Resident - 2005 Page 18

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