Form N-15 - Individual Income Tax Return Nonresident And Part-Year Resident - State Of Hawaii - Department Of Taxation 2005 Page 3
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4Form N-15 (Rev. 2005)
Page 3 of 4
Your Social Security Number
Your Spouse's SSN
!!! !! !!!!
!!! !! !!!!
}
Name(s) as shown on return
_____________________________________________________
MF053
33
First $2,594 of military reserve or Hawaii national
guard duty pay.............................................................
33l
34
Exceptional trees deduction (attach affidavit)
(see page 19 of the Instructions) ................................
34l
➤
35
Add lines 21 through 34 ...........Total Adjustments
35l
-
-
If negative number, place a minus sign (-)
If negative number, place a minus sign (-)
➤
l36l
36
Line 20 minus line 35 ......Adjusted Gross Income
!.!!
37
Ratio of Hawaii AGI to Total AGI.
Divide line 36, Column B, by line 36, Column A (Compute to 3 decimal places and round to 2 decimal places) .............
37l
•
CAUTION: If you can be claimed as a dependent on another person’s return, fill in this oval
and see the Instructions on page 19.
38
If you do not itemize deductions, enter zero on line 39 and go to line 40a.
Otherwise go to page 19 of the Instructions and enter your Hawaii itemized deductions here.
38a
Medical and dental expenses
TOTAL ITEMIZED
DEDUCTIONS
(from Worksheet NR-1 or PY-1)
....................................38al
39
If line 36, Column B is more than
38b
Taxes (from Worksheet NR-2 or PY-2)
.........................38bl
$100,000 ($50,000 for married
filing separately), see the
38c
Interest expense (from Worksheet NR-3 or
PY-3).........38cl
worksheet on page 40 of the
Instructions. If not, add lines 38a
38d
Contributions (from Worksheet NR-4 or
PY-4)..............38dl
through 38f. Enter total here and
38e
Casualty and theft losses
go to line 41
(from Worksheet NR-5 or PY-5)
....................................38el
38f
Miscellaneous deductions
(from Worksheet NR-6 or PY-6)
.....................................38fl
40a
If you checked filing status box:
[
]
1, enter $1,500
3, enter $950
Prorated Standard Deduction
2 or 5, enter $1,900
4, enter $1,650
..................40a
Multiply line 40a by the ratio on line 37 ..................................................................................... ➤
40b
40bl
If negative number, place a minus sign (-)
-
41
Line 36, Column B minus line 39 or 40b, whichever applies. (This line MUST be filled in)...........
41l
42a
Multiply $1,040 by the total number of exemptions claimed on line 6e. If you and/or your spouse are blind, deaf, or disabled,
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fill in the applicable oval(s)
Yourself
Spouse
and see page 25 of the Instructions
................................42a
Multiply line 42a by the ratio on line 37 ..............................................Prorated Exemption(s) ➤
42b
42bl
Taxable Income. Line 41 minus line 42b (but not less than zero)................Taxable Income ➤
43
43l
=
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=
44
Tax. Fill in oval if from:
Tax Table;
Tax Rate Schedule;
Form N-168;
Form N-615; or
Capital Gains Tax Worksheet on
page 40 of the Instructions. Enter the net capital gain
from the Capital Gains Tax Worksheet, line 14
.............44al
=
•
(
Include separate tax from Forms N-2, N-103, N-152, N-312, N-318, N-405,
N-586, or N-814) ................................................................................................................Tax ➤
44l
45
Total nonrefundable tax credits (attach Schedule CR)..................................................................
45
Line 44 minus line 45 (but not less than zero).............................................................Balance ➤
46
46
47
Hawaii State Income tax withheld, and
tax withheld on Forms N-2 or
N-4....................................47l
48
2005 estimated tax payments on
]
Forms N-1 _________ ; N-288A _________
...............48l
ID No 01
FORM N-15
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