Form N-15 - Individual Income Tax Return Nonresident And Part-Year Resident

FORM N-15 (REV. 2000)

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34 Hawaii adjusted gross income from line 33, Column B .......................................................................................

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35 Ratio of Hawaii AGI to Total AGI. Divide line 33, Column B, by line 33, Column A

(Compute to 3 decimal places and round to 2 decimal places)

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CAUTION: If you can be claimed as a dependent on another person’s return, check here

and see Instructions.

36 If you do not itemize deductions, enter zero on line 36g and go to line 37a. Otherwise go to page 19 of the

Instructions and enter your Hawaii itemized deductions here.

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36a Medical and dental expenses (from Worksheet NR-1 or PY-1)...................................

36a

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36b Taxes (from Worksheet NR-2 or PY-2)......................................................................

36b

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36c Interest expense (from Worksheet NR-3 or PY-3)......................................................

36c

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36d Contributions (from Worksheet NR-4 or PY-4) ...........................................................

36d

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36e Casualty and theft losses (from Worksheet NR-5 or PY-5) .........................................

36e

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36f Miscellaneous deductions (from Worksheet NR-6 or PY-6)........................................

36f

36g If line 34 is more than $100,000 ($50,000 for married filing separately), see the worksheet on page 38 of the

Instructions. If not, add lines 36a through 36f. Enter total here and go to line 38 ......Total Itemized Deductions

36g

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37a If you checked filing status box:

1, enter $1,500

3, enter $950

2 or 5, enter $1,900

4, enter $1,650

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37a

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37b Multiply line 37a by the ratio on line 35 .................................................................Prorated Standard Deduction

37b

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38 Line 34 minus line 36g or 37b, whichever applies. (This line MUST be filled in) .......................................................

39a Multiply $1,040 by the total number of exemptions claimed on line 6e. If you and/or your spouse are blind,

deaf, or disabled, check applicable box(es) • Yourself •

Spouse, and see page 25 of the Instructions 39a

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39b Multiply line 39a by the ratio on line 35 ............................................................................Prorated Exemption(s)

39b

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40 Taxable Income. Line 38 minus line 39b (but not less than zero) ............................................ Taxable Income

41 Tax. Check if from

Tax Table;

Tax Rate Schedule;

Form N-168;

Form N-615; or

Capital Gains Tax Worksheet on

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page 38 of the Instructions. Net capital gain from line 14 of Capital Gains Tax Worksheet

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(

Include separate tax from Forms N-2, N-103, N-152, N-312, N-405, N-586, or N-814)......................... Tax

42 Total nonrefundable tax credits (attach Schedule CR) ..............................................................................................

43 Line 41 minus line 42 (but not less than zero) ..........................................................................................Balance

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44 Hawaii State Income tax withheld and tax withheld on IHA distribution .......................

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45 2000 estimated tax payments on Forms N-1 _________ ; N-4 _________ ; N-288A _________ ..........

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46 Amount of estimated tax applied from 1999 return.....................................................

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47 Amount paid with extension(s) ..................................................................................

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48 Low-Income Refundable Tax Credit (attach Schedule X) DHS, etc. exemptions

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49 Credit for Low-Income Household Renters (attach Schedule X) .................................

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50 Credit for Child and Dependent Care Expenses (attach Schedule X)..........................

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51 Credit for Child Passenger Restraint System(s) (attach a copy of the invoice) .....................

52 Total refundable tax credits from Schedule CR (attach Schedule CR) ........................

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53 Add lines 44 through 52 .......................................................................................... Total Payments and Credits

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54 If line 53 is larger than line 43, enter the amount OVERPAID (line 53 minus line 43) ...............................................

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55 Amount of line 54 to be REFUNDED TO YOU .......................................................................................... Refund

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56 Amount of line 54 to be applied to your 2001 ESTIMATED TAX ...............................

57 If line 43 is larger than line 53, enter the AMOUNT YOU OWE (line 43 minus line 53). Use Form N-200V

to send your payment to the Department of Taxation. If you are filing your return late, see page 28 of the

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Instructions........................................................................................................................................Balance Due

58 Estimated tax penalty. (See page 29 of Instructions.) Also include this amount in

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line 54 or 57, whichever applies. Check box if Form N-210 is attached

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59 If you would like us to mail you a packet of forms for next year’s filing, please check this box ..................................

DECLARATION

I declare, under the penalties set forth in section 231-36, HRS, that this return (including accompanying schedules or statements) has been examined by me and, to the best of my knowledge and belief, is a true,

correct, and complete return, made in good faith, for the taxable year stated, pursuant to the Hawaii Income Tax Law, Chapter 235, HRS.

Your signature

Date

Spouse’s signature (if filing jointly, BOTH must sign)

Date

May the Hawaii Department of Taxation discuss this return with the preparer shown below? (See page 29 of the Instructions.)

Yes

Preparer’s

Preparer’s identification number

Paid

Signature

Check if