Form Ppb-8a - Disabled American Veteran Property Tax Relief Application Page 3
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4Part VII. Federal Adjusted Gross Income Calculation Worksheet
If you are not required to file a tax return, use this form to calculate your estimated federal adjusted gross income.
Income
$ _______________
Wages, salaries, tips, etc.
$ _______________
Taxable interest
$ _______________
Ordinary dividends
$ _______________
Alimony received
$ _______________
Business and/or farm income
$ _______________
Capital gain (or loss)
$ _______________
Other gain (or loss)
$ _______________
Taxable refunds, credits or offsets of state and local income taxes
$ _______________
Taxable amount of IRA distributions, pensions and annuities
$ _______________
Rental, royalties, partnerships, S corporations, trust income
$ _______________
Unemployment compensation
$ _______________
Taxable amount of social security benefits
See for calculation guidelines.
$ _______________
Other income
$ _______________
Total income
Adjustments to Income
$ _______________
Educator expenses
$ _______________
Certain business expenses of reservist
$ _______________
Health savings account deduction
$ _______________
Moving expenses
$ _______________
One-half of self-employment tax
$ _______________
Self-employed SEP, SIMPLE, and qualified plans
$ _______________
Self-employed health insurance deduction
$ _______________
Penalty on early withdrawal of savings
$ _______________
Alimony paid
$ _______________
IRA deduction
$ _______________
Student loan interest deduction
$ _______________
Tuition and fees deduction
$ _______________
Domestic production activities deduction
$ _______________
Total adjustments
Subtract:
$ ___________________ - $ ___________________ = $ __________________
Total Income
Total Adjustments
Federal Adjusted Gross Income Estimate
Questions? Please call us toll free at (866) 859-2254 (in Helena, 444-6900) or visit our website at
revenue.mt.gov.
PPB-8A
Rev. 10 12
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