Form 200-03 Ez - Delaware Individual Resident Income Tax Return - 2009

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DO NOT WRITE OR STAPLE IN THIS AREA
DELAWARE INDIVIDUAL RESIDENT
EZ
2009
INCOME TAX RETURN
FORM 200-03 EZ
or Fiscal year beginning
and ending
Reset
Your Social Security No.
Spouse’s Social Security No.
Print Form
(Attach Label Here) DO NOT COVER SOCIAL SECURITY NUMBERS
Your Last Name
First Name and Middle Initial
Jr., Sr., III., etc.
Spouse’s Last Name
Spouse’s First Name
Jr., Sr., III., etc.
Present Home Address (Number and Street)
Apt. #
City
State
Zip Code
FILING STATUS (MUST CHECK ONE)
If you were a part-year resident in 2009, give the dates you resided in Delaware.
1.
Single, Divorced,
2.
Joint
5.
Head of
From
2009
To
2009
Widow(er)
Household
Month
Day
Month
Day
CHECK IF: YOU WERE 65 OR OVER
BLIND
CHECK IF: SPOUSE WAS 65 OR OVER
BLIND
00
1
1.
ENTER AMOUNT FROM FEDERAL RETURN
(See instructions on
back).......................................................
00
2
2.
Pension/Retirement Exclusion
(See instructions on
back)................................................................................
00
3.
Delaware Adjusted Gross Income. Subtract Line 2 from Line 1........................................................................
3
4.
Standard Deduction:
Filing Statuses 1 & 5 Enter $3250
Filing Status 2 Enter $6500......................................................................................
4
00
5.
ADDITIONAL STANDARD DEDUCTION FROM WORKSHEET (See back)........................................................
5
00
6.
Add Lines 4 and 5............................................................................................................................................
6
00
7.
Subtract Line 6 from Line 3. This is your TAXABLE INCOME
00
7
Compute Tax on this Amount or Use the Tax Table.............................................................................................
00
8.
Tax Liability from Tax Table/Schedule................................................................................................................
8
00
9a. Enter number of exemptions claimed on Federal Return.
X $110........................................................
9a
9b. CHECK BOX(ES):
If you were 60 or over
Spouse was 60 or over (Filing Status 2)
00
9b
Enter number of boxes checked
X $110..............................................................................................
00
10
10. Tax imposed by State of
(Must attach copy of other state return and DE Schedule
I)........
00
11
11.
Earned Income Tax Credit.
See instructions on Page 8 for required documentation to
attach....................
00
12. TOTAL Non-Refundable Credits. Add Lines 9a, 9b, 10 & 11 and enter here........................................................
12
00
13. BALANCE. Subtract Line 12 from Line 8 and enter here. If Line 12 is greater than Line 8, enter “0” (ZERO)........
13
00
14. Delaware Tax Withheld
(Attach
W-2s/1099s)....................................................................................................
14
15. 2009 Estimated Tax and Extension Payments...................................................................................................
00
15
16. TOTAL Refundable Credits. Add Lines 14 and 15 and enter here ......................................................................
00
16
17. BALANCE DUE. If Line 13 is greater than Line 16, subtract Line 16 from Line 13 and enter here.......................>
00
17
18. OVERPAYMENT. If Line 16 is greater than Line 13, subtract Line 13 from Line 16 and enter here......................>
00
18
19. CONTRIBUTIONS TO SPECIAL FUNDS
DE Schedule III must be completed and attached.......................
19
00
00
20. AMOUNT OF LINE 18 TO BE APPLIED TO 2010 ESTIMATED TAX ACCOUNT................................
ENTER >
20
.....
00
21
21. PENALTIES AND INTEREST DUE. If Line 17 is greater than $400, see estimated tax instructions......ENTER >
00
22
22. NET BALANCE DUE. Add Lines 17, 19 and 21 and enter here...................................................PAY IN FULL >
00
23
23. NET REFUND. Subtract Lines 19, 20 and 21 from Line 18..........................
ZERO DUE/TO BE REFUNDED >
...
DIRECT DEPOSIT INFORMATION
If you would like your refund deposited directly to your checking or
savings account, complete boxes a, b, c and d below. See instructions for details.
DATE OF DEATH
SPOUSE
TAXPAYER
a. Routing Number
b. Type:
Checking
Savings
/
/
/
/
Month
Day
Year
Month
Day
Year
c. Account Number
d. Is this refund going to or through an account that is located outside of the United States?
Yes
No
NOTE: If your refund is adjusted by $100.00 or more, a paper check will be issued and mailed to the address on your return.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and believe it is true, correct and complete.
Your Signature
Date
Signature of Paid Preparer
Date
EIN,SSN or PTIN
X
X
Spouse’s Signature (If filing joint)
Date
Address
Zip Code
X
Home Phone
Business Phone
Business Phone
Email Address
Email Address

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