Form 760py 2009 - Virginia Part-Year Resident Income Tax Return 2010 (Page 2 of 2) in pdf

*VA760P209000*

Form 760PY (2009)

Page 2

name

SSn

PArt I - ScheduLe oF Income And AdjuStmentS (See instructions)

—ALL FILerS MUST comPLete thIS ScheduLe—

enter SPouSe’S Income When FILInG StAtuS 4 IS uSed

For uSe BY ALL other FILerS

column A1

column A2

column A3

column B1

column B2

column B3

Income on

Income While

Income While not

Income on

Income While

Income While not

28 Income:

Federal Return

Virginia Resident

Federal Return

Virginia Resident

(a) Wages, salaries, tips and other compensation .......28(a)

(b) Interest and dividends ................................................(b)

29 gross income [add Lines 28 (a), (b) and (c)] .....................29

30 Adjustments to income: moving expenses ........................30

31 other income adjustments (attach explanation) ................31

32 Adjusted gross income (Line 29 less Lines 30 and 31)* ....32

(a) Net fixed date conformity modifications ........................(a)

(b) Fixed date conformity FAgI [add Lines 32 and 32(a)] ..(b)

*enter the amount from Line 32, Col. A1 on Page 1, Line 6 Col. A. enter the amount from Line 32, Col. B1 on Page 1, Line 6, Col. B.

Yourself

PArt II - AddItIonS to FederAL AdjuSted GroSS Income

Spouse -USe onLY

For use by all

when Filing Status 4

other filers

is checked

33 Fixed date conformity addition ...............................................................................................................................33

34 Interest earned while a Virginia resident on obligations of other states exempt from federal tax ...........................34

35 other additions to federal adjusted gross income as provided in instructions - Attach explanation .......................35

36 totAL ADDItIonS (add Lines 33 through 35) enter here and on Line 7 on Page 1 ............................................36

PArt III - SuBtrActIonS From FederAL AdjuSted GroSS Income

37 Fixed date conformity subtraction ...........................................................................................................................37

38 Age deduction from Sch. nPY, Part I, Line 4 ..........................................................................................................38

39 State income tax refund or overpayment credit reported as income on your federal return and

received while a Virginia resident. (Claim in the same column you reported the income on Line 6.) .....................39

40 Income attributable to your period of residence outside Virginia from Part I, Columns A3 and B3, Line 32(b) ......40

41 Income (interest, dividends or gains) received while a Virginia resident on obligations or

securities of the U.S. exempt from state income tax, but not from federal tax ......................................................41

42 Social Security and equivalent Tier 1 Railroad Retirement Act benefits reported as taxable

income on your federal return and attributable to your period of residence in Virginia ...........................................42

43 Disability income received while a Virginia resident and reported as wages

Spouse

(or payment in lieu of wages) on account of permanent and total disability

You..........................43

You cannot claim an Age Deduction on Line 38 and the disability subtraction. See instructions.

44 other subtractions - refer to the instruction book for other Subtraction Codes

(a) enter 2 digit code in box

...................... 44(a)

(b) enter 2 digit code in box

.......................... (b)

...........................(c)

45 totAL SUBtRACtIonS - (add Lines 37 through 44c). enter here and on Line 9 on Page 1 ..............................45

PArt IV - StAndArd deductIon

(the standard deduction must be claimed unless itemized deductions were claimed on your federal return - see instructions.)

46 (a) Fixed date conformity Federal ADjUSteD gRoSS InCome (total of Line 32(b), Columns A1 + B1 from Part I above) .................... 46(a)

(b) Fixed date conformity income attributable to Virginia residence (total of Line 32(b), Columns A2 + B2 from Part I above) ..................... (b)

46(a)]. enter to only one decimal place (ex.: 12.2%) ................................................................................................................................ (c)

(d) Filing Status 1: enter $3,000; Filing Status 2 or 4: enter $6,000; Filing Status 3: enter $3,000 ............................................................... (d)

(e) multiply Line 46(c) by Line 46(d). enter here and on Line 11(a) on front. If using Filing Status 4,

you may allocate this amount between husband and wife, as mutually agreed ........................................................................................ (e)

PArt V - ItemIZed deductIonS

(If you itemized deductions on your federal return, You muSt claim itemized deductions on your Virginia return.)

47 (a) Itemized deductions from Schedule A Worksheet paid while a Virginia resident ................................................................................... 47(a)

(b) State and local income taxes claimed on Schedule A and included on Line 47(a) .................................................................................... (b)

If using Filing Status 4, you may allocate this amount between husband and wife, as mutually agreed .................................................. (c)

I (We) authorize the Department of taxation to discuss this return with my (our) preparer.

I (We), the undersigned, declare under penalty of law that I (we) have examined this return and to the best of my (our) knowledge, it is a true, correct and

complete return. We agree that filing separately on this combined return makes us jointly and severally liable for the amount of tax shown to be due on this

return and any refunds will be made payable to us jointly.

Your Signature

Date

Your Business Phone number

Home Phone number

Check if

Deceased

Spouse's Signature (if filing status 2 or 4 both must sign)

Date

Spouse's Business Phone Number

Check if

Please