Form 40nr - Alabama Individual Income Tax Return

Form 40NR (2004)

Page 2

B — All Sources

C — Alabama Sources

PART I

Interest and dividend income (attach Schedule B if over $1500.00) . . . . . . . . . . . . . . . . . . . . .

Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Taxable portion of pensions and annuities (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Business income or (loss) (attach Federal Schedule C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gain or (loss) from sale of Real Estate, Stocks, Bonds, etc. (attach Schedule D) . . . . . . . . . .

Other

Rents, Royalties, Partnerships, Estates, Trusts, etc. (attach Schedule E) . . . . . . . . . . . . . . . .

Income

Farm income or (loss) (attach Federal Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(see page 10)

Other income (state nature and source)

Total other income. Add lines 1 through 8, column B, and lines 1, 4 through 8, column C.

Enter here and also on page 1, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IRA deduction, Keogh retirement plan, and self-employed SEP deduction . . . . . . . . . . . . . . .

PART II

Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Moving Expenses (Attach Federal Form 3903) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adjustments

Place of new employment: City _______________________ State _______ ZIP ________

to income

Self-employed health insurance deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(see page 12)

Add lines 1 through 4. Enter here and also on page 1, line 9, columns B and C . . . . . . . .

Alimony Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART III

Adoption Expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add lines 1 and 2, enter here and on page 1, line 12, column B. . . . . . . . . . . . . . . . . . . . . . . . .

Other

Enter percentage from page 1, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adjustments

Multiply line 3 by line 4. Enter here and also page 1, line 12, column C . . . . . . . . . . . . . . . . . .

If you are filing separately on your Alabama return and jointly on your Federal return,

PART IV

B — All Sources

C — Alabama Sources

complete all lines below. Otherwise, omit lines 1 through 4.

Adjusted total income (from page 1, line 10, columns B and C) . . . . . . . . . . . . . . . . . . . . . . . . .

Spouse's federal adjusted gross income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Federal

Add lines 1 and 2, column B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Income Tax

Divide line 1, column C, by line 3, column B. Enter percentage here and on line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deduction

Enter Federal Income Tax Liability as shown on your 2004 return. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(see page 12)

If you completed lines 1 through 4 above, enter percentage from line 4. Otherwise, enter percentage from page 1, line 11 . . . . . .

Federal Income Tax deduction allowable.

Multiply the amount on line 5 by percentage on line 6. Enter here and on page 1, line 15. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See instructions for definition of a dependent. NOTE: If you checked filing status 3 (Married filing separate return), you may claim only the

PART V

dependent(s) for whom you separately furnished over 50% of the total support.

(4) Did you provide

Dependents:

(2) Dependent’s

(3) Dependent’s

more than one-half

(1) First name

Last name

social security number.

relationship to you.

dependent's support?

Dependents

Do not include

yourself or

b Total number of dependents claimed above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

your spouse

Multiply $300 by the total number of dependents claimed on line 1b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(see page 13)

Enter percentage from page 1, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dependent exemption allowable. Multiply the amount on line 2 by the percentage on line 3.

Enter here and on page 1, line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PART VI

Name of state of which you were a legal resident in 2004

Did you file a return with that state for 2004?

Yes

No If no, state reason why:

If married, did your spouse receive a separate income for 2004?

Yes

If yes, is your spouse filing a separate Alabama return?

Yes

If yes, enter name here.

General

Did you file an Alabama return for 2003?