Form 200-02-X - Non-Resident Amended Personal Income Tax Return - 2016 Page 2
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1
2FORM 200-02-X
2016
Page 2
*DF21216029999*
NON-RESIDENT AMENDED
DF21216029999
PERSONAL INCOME TAX RETURN
NOTE: IF YOUR ORIGINAL RETURN WAS FILED USING TWO SEPARATE FORMS, YOU MUST FILE TWO SEPARATE AMENDED FORMS
IS AN AMENDED FEDERAL RETURN BEING FILED?.........................................................................................................
YES
NO
IF NO, PLEASE EXPLAIN. IF THE CHANGES PERTAIN TO THE DE RETURN ONLY, LIST THE LINE NUMBERS BEING AMENDED.
YES
NO
HAS THE DELAWARE DIVISION OF REVENUE ADVISED YOU YOUR ORIGINAL RETURN IS BEING AUDITED?.........
IS THIS AMENDED RETURN BEING FILED AS A PROTECTIVE CLAIM?........................................................................
YES
NO
A DETAILED EXPLANATION OF ALL CHANGES MUST BE PROVIDED IN THIS SPACE. ALL SUPPORTING SCHEDULES AND/ OR DOCUMENTATION MUST BE ATTACHED
.
Federal
DE Source Income/ Loss
SECTION A - INCOME AND ADJUSTMENTS FROM FEDERAL RETURN
COLUMN 1
COLUMN 2
27.
Wages, salaries, t ips, et c................................................................................................................................
28.
Int erest .............................................................................................................................................................
29.
Dividends.........................................................................................................................................................
s of st at e & local income t axes.................................................................
31.
Alimony received............................................................................................................................................
32.
Business income or (loss) (See inst ruct ions)...............................................................................................
33a. Capit al gain or (loss)......................................................................................................................................
33b. Ot her gains or (losses)...................................................................................................................................
34.
IRA dist ribut ions............................................................................................................................................
35.
Taxable pensions and annuit ies...................................................................................................................
36.
Rent s, royalt ies, part nerships, S corps, est at es, t rust s, et c.......................................................................
37.
Farm income or (loss)....................................................................................................................................
38.
Unemployment compensat ion (insurance).................................................................................................
s...................................................................................................................
40.
Ot her income (st at e nat ure and source)
41.
Tot al income. Add Lines 27 t hrough 40......................................................................................................
42.
Tot al Federal Adjust ment s (See inst ruct ions)............................................................................................
43.
Federal Adjust ed Gross Income for Delaware purposes. Subt ract Line 42 from 41...............................
SECTION B - DELAWARE MODIFICATIONS AND ADJUSTMENTS - ADDITIONS ( + )
COLUMN 1
COLUMN 2
44.
Int erest received on obligat ions of any st at e ot her t han Delaware........................................................
45.
Fiduciary adjust ment , oil deplet ion............................................................................................................
46.
TOTAL - Add Lines 44 & 45...........................................................................................................................
47.
Add Lines 43 & 46..........................................................................................................................................
COLUMN 1
COLUMN 2
SECTION C - DELAWARE MODIFICATIONS AND ADJUSTMENTS - SUBTRACTIONS ( - )
48.
Int erest received on U.S. Obligat ions..........................................................................................................
49.
Pension/ Ret irement Exclusions (See instructions) ..................................................................................
50.
Delaware St at e t ax refund . .......................
. . .
. . .
. . .
. . . . .
. . . .
.................... . .................................................................
51.
Fiduciary Adjust ment , Work Oppor t unit y Credit , Delaware NOL Carryforward.....................................
53.
TOTAL - Add Lines 48 t hrough 52................................................................................................................
54.
Subt ract Line 53 from Line 47 and ent er here............................................................................................
55.
Exclusion for cert ain persons 60 and over or disabled (See inst ruct ions)..............................................
Column 2.
56A.
Enter on front side Line 6, Box A
......................................................................................................................................................
Column 1. Subt ract Line 55 from Line 54. This is your Delaware Adjust ed Gross Income.
56B.
Enter on front side Line 1 and Line 6, Box B .
..........................................................................................
COLUMN 1
SECTION D - ITEMIZED DEDUCTIONS (ATTACH FEDERAL SCHEDULE A, FORM 1040)
57. Ent er t ot al It emized Deduct ions (If Filing Status 3, see instructions) ....................................................
58. Ent er Foreign Taxes Paid (See inst ruct ions)................................................................................................
59. Ent er Charit able Mileage Deduct ion (See inst ruct ions).............................................................................
60. TOTAL - Add Lines 57, 58, and 59 ................................................................................................................
61a. Ent er St at e Income Tax included in Line 57 above (See Inst ruct ions)....................................................
61b. Ent er Form 700 Tax Credit Adjust ment (See inst ruct ions)........................................................................
62.
Subt ract Line 61a and 61b from Line 60. Ent er here and on front , Line 2..............................................
Toll-free telephone number (Delaware only) 1-800-292-7826
(Rev 09/2016)
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