Form 1040n - Nebraska Individual Income Tax Return

18 Amount from line 17 (Total Nebraska tax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

19 Nebraska personal exemption credit for residents only ($118 per exemption) . . 19

20 Credit for tax paid to another state $__________ (attach Nebr . Sch . II and the

other state's return) plus prior year AMT credit (attach Form 8801) $___________ .

Enter the total on line 20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

21 Credit for the elderly or disabled (attach copy of Federal Schedule R) . . . . . . . . . . 21

22 CDAA credit (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

23 Form 3800N nonrefundable credit (attach Form 3800N) . . . . . . . . . . . . . . . . . . . . . 23

24 Nebraska child/dependent care nonrefundable credit, only if line 5 is more

than $29,000 (attach a copy of Federal Form 2441 and see instructions) . . . . . . . . . . 24

25 Credit for financial institution tax (see instructions) (attach Form NFC) . . . . . . . . . . 25

26 Total nonrefundable credits (add lines 19 through 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

27 Subtract line 26 from line 18 (if line 26 is more than line 18, enter -0-) . If result is more than your

federal tax liability (and line 12 is less than $5,000), see instructions . If entering federal tax, check box:

and attach a copy of the federal return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

28 Nebr . income tax withheld (attach 2010 Forms W-2, W-2G, 1099-R,1099-MISC, or 14N) 28

29 2010 estimated tax payments (include any 2009 overpayment credited to 2010 and

any payments submitted with an extension request) . . . . . . . . . . . . . . . . . . . . . . . . . 29

30 Form 3800N refundable credit (attach Form 3800N) . . . . . . . . . . . . . . . . . . . . . . . . 30

31 Nebraska child/dependent care refundable credit, if line 5 is $29,000 or less

(attach a copy of Federal Form 2441 or Nebraska Form 2441N) . . . . . . . . . . . . . . . . . . 31

32 Beginning Farmer credit (attach Form 1099 BFC) . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

33 Nebraska earned income credit . Enter number of qualifying children

Federal credit

.00 x .10 (10%) (attach federal return,

pages 1 and 2 – see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

34 Add lines 28 through 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

35 Penalty for underpayment of estimated tax (see instructions) . If you calculated a Form 2210N penalty of zero

or greater, or used the annualized income method, attach Form 2210N, and check this box:

. . . . . . . . 35

36 TOTAL TAX AND PENALTY. Add lines 27 and 35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

37 Use tax due on Internet and out-of–state purchases . Enter:

Purchases subject to tax

$___________;

State tax

$ _________ .00 (purchases x 5 .5%); Local code

__ __ __ (see local rate schedule);

Local tax

$ _________ .00 (purchases x local rate of _____%, from local rate schedule)

Total tax

$ _________ .00 Add state and local taxes and enter on line 37 . If no use tax, enter zero (-0-) on line 37 . 37

38 TOTAL AMOUNT DUE . If line 34 is less than total of lines 36 and 37, subtract line 34 from the total of

lines 36 and 37 . Pay this amount in full . For credit card payment check here

and see instructions . . . . . 38

39 OVERPAYMENT. If line 34 is more than total of lines 36 and 37, subtract total of lines 36 and 37 from line 34 . 39

40 Amount of line 39 you want APPLIED TO YOUR 2011 ESTIMATED TAX . . . . . . .

41 Wildlife Conservation Fund DONATION of $1 or more . . . . . . . . . . . . . . . . . . . . . .

42 Nebraska Campaign Finance CONTRIbUTION of $1 or more . . . . . . . . . . . . . . . . . 42

43 Amount of line 39 you want REFUNDED to you (line 39 minus lines 40, 41, and 42) .

Allow at least 4 months to

receive your refund if you file a paper return

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Expecting a Refund? Have it sent directly to your bank account!

(see instructions)

44a Routing Number

44b Type of Account

1 = Checking

2 = Savings

(Enter 9 digits, first two digits must be 01 through 12, or 21 through 32;

use an actual check or savings account number, not a deposit slip)

44c Account Number

(Can be up to 17 characters . Omit hyphens, spaces, and special symbols . Enter from left to right and leave any unused boxes blank .)

44d

Check this box if this refund will go to a bank account outside the United States .

Under penalties of perjury, I declare that, as taxpayer or preparer, I have examined this return and to the best of my knowledge and belief, it is correct and complete .

sign

here

Your Signature

Date

E-Mail Address

(

)

Keep a copy of

this return for

Spouse’s Signature (if filing jointly, both must sign)

Daytime Phone

your records .