Form N-15 - Individual Income Tax Return Nonresident And Part-Year Resident - State Of Hawaii - Department Of Taxation 2005 Page 4
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4Form N-15 (Rev. 2005)
Page 4 of 4
Your Social Security Number
Your Spouse's SSN
!!! !! !!!!
!!! !! !!!!
}
Name(s) as shown on return
_____________________________________________________
MF054
49
Amount of estimated tax applied from 2004
return..........49l
50
Amount paid with extension(s)
........................................50l
51
Low-Income Refundable Tax Credit
•
(attach Schedule X) DHS, etc. exemptions
....51l
52
Credit for Low-Income Household
Renters (attach Schedule X)
...........................................52l
53
Credit for Child and Dependent Care
Expenses (attach Schedule X)
........................................53l
54
Credit for Child Passenger Restraint
System(s) (attach a copy of the invoice)
.........................54l
-
55
Total refundable tax credits from
If negative number, place a minus sign (-)
Schedule CR (attach Schedule
CR)...................................55
-
If negative number, place a minus sign (-)
Add lines 47 through 55 .............................................................Total Payments and Credits ➤
56
56l
57
If line 56 is larger than line 46, enter the amount OVERPAID (line 56 minus line 46) ..................
57l
58
Amount of line 57 to be applied to
your 2006 ESTIMATED
TAX...........................................58l
59
Line 57 minus line 58 ....................................................................................................................
59l
=
=
60
Contributions to (See Instructions) :
Yourself
Spouse
=
=
l
l
60a Hawaii Schools Repairs and Maintenance Fund .................
$2
$2
=
=
l
l
60b Hawaii Public Libraries Fund ................................................
$2
$2
l
l
60c Domestic Violence / Child Abuse and Neglect Funds .........
$5
$5
61
Add the amounts relating to the filled ovals on lines 60a through 60c and enter here ..................
61
62
Amount to be REFUNDED TO YOU (line 59 minus line 61) If filing late,
see page 30 of Instructions ...........................................................................................................
62l
63
AMOUNT YOU OWE (line 46 minus line 56). Send Form N-200V with your payment. ................
63l
64
Estimated tax penalty. (See page 30 of Instructions.)
=
Do not include this amount in line 57 or 63. Fill in
•
=
this oval if Form N-210 is attached ➤
...................64l
•
65
If you would like us to mail you a packet of forms for next year’s filing, please fill in this oval ...........................................................................
If designating another person to discuss this return with the Hawaii Department of Taxation, complete the following. This is not a full power of
attorney. See page 31 of the Instructions.
Designee’s name ➤
Phone no. ➤
Identification number ➤
=
=
*
=
=
Note: Filling in the “Yes”
Do you want $2 to go to the Hawaii Election Campaign Fund?
Yes
No
HAWAII ELECTION
oval will not increase your
CAMPAIGN FUND
If joint return, does your spouse want $2 to go to the fund?
Yes
No
tax or reduce your refund.
DECLARATION — I declare, under the penalties set forth in section 231-36, HRS, that this return (including accompanying schedules or state-
ments) has been examined by me and, to the best of my knowledge and belief, is a true, correct, and complete return, made in good faith, for
the taxable year stated, pursuant to the Hawaii Income Tax Law, Chapter 235, HRS.
Your signature
Date
Your occupation
Daytime Phone Number
➤
(
)
Spouse’s signature (if filing jointly, BOTH must sign)
Date
Spouse's occupation
➤
Preparer’s
Date
Preparer’s identification number
Check if
o
➤
➤
self-employed
Signature
Paid
Print
➤
Preparer’s
Federal E.I. No. ➤
Preparer’s Name
Information
]
Firm’s name (or yours
➤
Phone No. ➤
if self-employed),
ID No 01
FORM N-15
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