Schedule Co Individual - Optional Computation Of Tax (Short Form) - 2011 Page 2
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2Rev. Feb 13 12
Schedule CO Individual (Short Form) - Page 2
B - TAXPAYER
C - SPOUSE
6.
DEDUCTIONS INDIVIDUALLY ALLOCATED (See instructions):
18
00
00
A) Contributions to governmental pension or retirement systems ..............................................................................
(01)
(39)
B) Contributions to individual retirement accounts (Do not exceed from $5,000 each):
Financial inst.
Account No.
Employer Ident. No.
Contribution
(02)
(05)
(03)
(06)
(04)
(07)
00
Total contributions to individual retirement accounts (Distribute the amount as it corresponds to the taxpayer and spouse)
00
(08)
(40)
C) Contributions to health savings accounts with a high annual deductible medical plan (See instructions):
Contribution
Institution
Account No.
Employer Ident. No.
________________
_________________________
________________________
_______________________
(11)
(15)
Effective
Annual deductible
____________ Type of
1 Individual
2 Individual and age 55 or older
(09)
(12)
date
coverage:
3 Family
4 Family and age 55 or older
(16)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Contribution
Institution
Account No.
Employer Ident. No.
________________
_____________________
_________________________
_______________________
(13)
(17)
Effective
Annual deductible
____________ Type of
1 Individual
2 Individual and age 55 or older
(10)
(14)
date
coverage:
3 Family
4 Family and age 55 or older
(18)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Total contributions (Add the smaller amount between the contribution and the annual deductible of each account.
00
00
Distribute the amount as it corresponds to the taxpayer and spouse) ..............................................................
(41)
(19)
00
00
D) Educational Contribution Account (Complete line 15) (See instructions) ............................................................
(42)
(20)
E) Interest paid on students loans at university level (See instructions):
Financial inst.
Loan No.
Employer Ident. No.
Amount
(21)
(23)
(22)
(24)
00
00
Total interest paid on students loans ......................................................................................................
(43)
(25)
F) Total deductions individually allocated (Add lines 6A through 6E, Columns B and C,
00
00
respectively) .........................................................................................................................................................................
(44)
(26)
00
00
7.
Additional Personal Exemption for Veterans (See instructions) ...........................................................................
(45)
(27)
3,500
3,500
00
00
8.
PERSONAL EXEMPTION ...............................................................................................................................
(46)
(28)
9.
EXEMPTION FOR DEPENDENTS (Complete Part 2 of the return, see instructions)
00
A)
__________ X $2,500 ....................................................................................
(30)
(29)
00
B)
__________ X $1,250 ....................................................................................
(32)
(31)
00
C) Total exemption for dependents (Add lines 9A and 9B) ...............................................
(33)
00
00
D) Enter 50% of the total of line 9C in Columns B and C ..............................................................................................
(47)
(34)
00
00
10.
SPECIAL DEDUCTION FOR CERTAIN INDIVIDUALS (See instructions) ..........................................................
(48)
(35)
00
00
11.
Total Deductions and Exemptions (Add lines 5G, 6F, 7, 8, 9D and 10, Columns B and C, respectively) .............
(49)
(36)
00
00
12.
NET TAXABLE INCOME (Subtract line 11 from line 4. If line 11 is larger than line 4, enter zero) ..................................................
(50)
(37)
13.
Tax Determined Individually (Use the Tax Table and the amount entered in Columns B
00
and C of line 12 to determine the tax individually. See instructions) .....................................................................
00
(51)
(38)
14.
TOTAL TAX DETERMINED (Add the amounts of Columns B and C of line 13 and transfer it to Part 1, line 12 of the Short
00
Form) .................................................................................................................................................................................
(60)
Continue in Part 1, line 12 of the Short Form.
57
BENEFICIARIES OF EDUCATIONAL CONTRIBUTION ACCOUNTS (See instructions)
15.
Date of Birth (Day/Month/Year)
(01)
Name, Initial
Last Name
Second Last Name
Social Security Number
Contributed Amount
Relationship
(Not to exceed from $500 each)
Financial institution
Account number
Employer Identification Number
00
Name, Initial
Last Name
Second Last Name
Date of Birth (Day/Month/Year)
Contributed Amount
(02)
Social Security Number
Relationship
(Not to exceed from $500 each)
Financial institution
Account number
Employer Identification Number
00
(03)
Social Security Number
Name, Initial
Last Name
Second Last Name
Date of Birth (Day/Month/Year)
Relationship
Contributed Amount
(Not to exceed from $500 each)
Account number
Financial institution
Employer Identification Number
00
(10)
Total contributions (Add lines (01) through (03) and transfer to line 6D, Column B or C, as applicable) .......................................
00
Retention Period: Ten (10) years
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