Form 39nr - Idaho Supplemental Schedule - 2004 Page 2
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Form 39NR (2004)
TC39NR041-2
Page 2
9-21-04
Name(s) as shown on return
Social Security Number
C. Credit for Income Tax Paid to Other States by Part-Year Residents. See instructions, page 30.
Nonresidents cannot claim this credit. Idaho residents on active military duty, complete Section D below.
1. Idaho adjusted income from line 34, Column B, Form 43 ............................
1
00
Attach a copy of the
2. Other state's adjusted income .....................................................................
2
00
income tax return and a
separate Form 39NR for
3. Amount on lines 1 and 2 taxed by both states ..............................................
3
00
each state for which a
4. Idaho tax, line 45, Form 43 ..........................................................................
4
00
credit is claimed.
5. Divide line 3 by line 1. Enter percentage here. ............................................
%
5
6. Multiply line 4 by line 5. .......................................................................................................................
6
00
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
7. Other state's tax due less its income tax credits ............................................
7
00
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
8. Divide line 3 by line 2. Enter percentage here. .............................................
8
%
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
9. Multiply line 7 by line 8. .......................................................................................................................
9
00
10. Enter the smaller of line 6 or 9 here and on line 46, Form 43.
10
00
D. Credit for Income Tax Paid to Other States by Idaho Residents on Active Military Duty.
See instructions, page 30.
1. Idaho tax, line 45, Form 43 ...........................................................................
1
00
Attach a copy of the
income tax return and a
2. Other state's adjusted income ......................................................................
2
00
separate Form 39NR for
3. Idaho adjusted income from line 34, Column B, Form 43 .............................
3
00
each state for which a
credit is claimed.
%
4. Divide line 2 by line 3. Enter percentage here. ..............................................
4
5. Multiply line 1 by line 4. Enter amount here. ........................................................................................
5
00
6. Other state's tax due less its income tax credits ...................................................................................
6
00
7. Enter the smaller of line 5 or 6 here and on line 46, Form 43.
7
00
E. Maintaining a Home for a Family Member Age 65 or Older, or a Family Member With a
Developmental Disability. See instructions, page 31.
1.
Did you maintain a home for an immediate family member age 65 or older and provide more than
Yes
No
one-half of his/her support? You and your spouse do not qualify. .......................................................
2.
Did you maintain a home for an immediate family member with a developmental disability and
Yes
No
provide more than one-half of his/her support? You and your spouse may qualify. .............................
If you answered YES to either question, complete lines 3 and 4.
3.
List each family member you are claiming:
Check here if
Date of Birth of
Social Security Number
Relationship to Person
Name of Family Member
developmentally
Family Member
disabled
First Name
Last Name
of Family Member
Filing Return
4.
Total amount claimed ($100 for each qualifying member but not more than $300).
Enter on line 66, Form 43. (Credit cannot be claimed if you took $1,000 deduction on Part B,
line 11.)
00
4
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
F. Recapture of Idaho Credits. See instructions, page 31.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3
1. Tax from recapture of investment tax credit. Attach Form 49R. ............................................................
1
00
2
2. Tax from recapture of broadband equipment investment credit. Attach Form 68R. ..............................
00
3. Tax from recapture of incentive investment tax credit. Attach Form 69R. .............................................
3
00
4. Total recapture of Idaho credits. Add lines 1, 2, and 3. Enter on line 59 Form 43.
00
4
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