DIVISION OF REVENUE AND TAXATION
COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS
COMPUTATION OF NON-REFUNDABLE CREDIT AND
APPLICATION FOR REBATE ON CNMI SOURCE INCOME TAX
2008
Form OS-3405A
(Attach to Form 1040CM)
(SEE INSTRUCTIONS ON REVERSE SIDE)
Your
name and initial
Last name
Your social security number
If a joint return, spouse’s
name and initial
Last name
Spouse’s social security number
Name and
Address
Home address (number and street).
Apt. No.
IMPORTANT !
City, town, or post
state and ZIP code.
You must enter SSN(s) above
PART A
NON-REFUNDABLE CREDITS
1
Wage and salary tax…………………………………………………………………………….......................................... 1
2
Earnings tax……………………………………………………………………………………............................................ 2
3
Business gross revenue tax
Name
Tax ID No.
a)
a
b)
b
c)
c
4
User fees paid………………………………………………………………………………................................................ 4
5
Fees and taxes imposed under 4CMC § 2202(h)………………………………………................................................ 5
6
Total non-refundable credits (add lines 1 through 5)…………………………………………………………………………………...................................................... 6
PART B
REBATE COMPUTATION
7
Allocable percentage:
a
Tax without the CNMI
7a
%
b
Tax within the CNMI
7b
%
8
Total NMTIT on all sources……………………………………….................................................................................. 8
9
Total NMTIT payments made……………………………………….............................................................................. 9
10
Tax on sources without CNMI. (multiply line 8 by the percentage as shown on line 7a)……………………..................................................................................... 10
11
Tax on sources within CNMI. (multiply line 8 by the percentage as shown on line 7b)….......................................... 11
12
Total non-refundable credits. (enter amount from line 6, Part A)……………………….............................................. 12
13
Rebate base amount. (subtract line 12 from line 11. If zero or less, enter -0-)………………………………………………............................................................ 13
14
Total CNMI and NON-CNMI source tax after non-refundable credits. (add lines 10 and 13)………….......................................................………………………… 14
15
NMTIT overpayment. (subtract line 14 from line 9. If zero or less, enter -0-)………………………………………………….....................................................…… 15
16
NMTIT underpayment. (if line 14 is greater than line 9, subtract line 9 from line 14, otherwise, enter -0-)……………………….................................................... 16
17
Rebate offset amount. Calculate this amount as determined by the rebate base (line 13) using Rebate Table provided in Part B on reverse…....................... 17
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are
true, correct, and complete. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge.
Your signature
Date
Your occupation
Daytime phone number
(
)
Spouse’s signature. If a joint return, both must sign
Date
Spouse’s occupation
Preparer’s
Date
Check if
Preparer’s SSN or PTIN
signature
self-employed
EIN
Firm’s name (or yours if self-
employed) address and Zip code.
(
)
Phone no.
Form OS-3405A-2008
DEADLINE: APRIL 15, 2009