Fillable Form Tc-40s - Income Tax Supplemental Schedule printable pdf download

Form Tc-40s - Income Tax Supplemental Schedule

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40063

Income Tax Supplemental Schedule

TC-40S

Rev. 12/06

Last name

SSN

Part 1 - Additions to Income (write the code and amount of each addition to income, see pages 5 and 6)

Code

5 1

Lump sum distribution

5 6

Child's income excluded from parent's return

5 2

State taxes allocated from estate/trust

5 7

Municipal bond interest

5 3

Medical Savings Account (MSA)

6 0

Untaxed income of a resident trust

5 4

Utah Educational Savings Plan (UESP)

6 1

Untaxed income of a nonresident trust

5 5

Reimbursed adoption expenses

6 9

Equitable adjustments

Total additions to income (add all additions to income and enter total here and on TC-40, line 6)

Part 2 - Other Deductions (write the code and amount of each other deduction, see pages 7 through 9)

Code

7 1

Interest from U.S. Government Obligations

7 8

Railroad retirement income

7 2

Medical Savings Account (MSA)

7 9

Equitable adjustments

Utah Educational Savings Plan (UESP)

Gains on capital transactions

7 3

8 1

7 4

Health care insurance premiums

8 2

Nonresident active duty military pay

7 5

Long-term care insurance premiums

8 5

State tax refund distributed to trust beneficiary

7 6

Adoption expenses

7 7

Native American income:

Enrollment Number & Tribe - Primary

Secondary

Total other deductions (add all other deductions and enter total here and on TC-40, line 13)

Part 3 - Nonrefundable Credits (write the code and amount of each nonrefundable credit, see pages 10 through 12)

Code

0 1

At-home parent

0 9

Hiring disabled

0 2

Qualified sheltered workshop - enter name below

1 0

Recycling market

1 1

Tutoring disabled

0 3

Renewable energy systems

1 2

Research activities

0 5

Clean fuel vehicle

1 3

Research machinery/equipment

0 6

Historic preservation

1 7

Tax paid to another state (attach TC-40A)

0 7

Enterprise zone

1 9

Live organ donation expenses

0 8

Low-income housing

Total nonrefundable credits (add all nonrefundable credits and enter total here and on TC-40, line 20)

Part 4 - Refundable Credits (write the code and amount of each refundable credit, see pages 14 and 15)

Code

4 0

Targeted business tax credit

4 6

Mineral production withholding

4 1

Special needs adoption credit

4 7

Agricultural off-highway gas/undyed diesel

4 3

Nonresident shareholder's withholding

4 8

Farm operation hand tools

FEIN -

Total refundable credits (add all refundable credits and enter total here and on TC-40, line 30)

Form Tc-40s - Income Tax Supplemental Schedule

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