Form It-140nr/py - West Virginia Nonresident/part-Year Resident Income Tax Return - 2002 Page 3
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3WEST VIRGINIA SCHEDULES M and E
Modifications INCREASING federal adjusted gross income (additions)
51.
Interest or dividend income on federal obligations which is exempt from federal tax but subject to state tax ........
51
52.
Interest or dividend income on state and local bonds other than bonds from West Virginia sources ....................
52
53.
Interest on money borrowed to purchase bonds earning income exempt from West Virginia tax ........................
53
54.
Qualifying 402(e) lump-sum income NOT included in federal adjusted gross income but subject to state tax ......
54
55.
Other income deducted from federal adjusted gross income but subject to state tax ............................................
55
56.
Withdrawals from a medical savings account NOT used for payment of qualifying medical expenses .................
56
57.
TOTAL ADDITIONS (add lines 51 through 56). Enter here and on line 3 of Form IT-140NR/PY .........................
57
Modifications DECREASING federal adjusted gross income (subtractions)
58.
Interest or dividends received on United States or West Virginia obligations
Column A (You)
Column B (Spouse)
58
includible in federal adjusted gross income but exempt from state tax ..............................
59.
Total amount of any benefit (including survivorship annuities) received from
59
any West Virginia state or local police, deputy sheriff’s or firemen's retirement system .....
60.
Up to $2,000 of benefits received from West Virginia Teachers Retirement System,
West Virginia Public Employees Retirement System, federal retirement systems
60
(Title 4 USC § 111), and any form of military retirement..........................................................
61.
Military Retirement Modification (Enclose 1099R)
2% x years of service____________, x military retirement income (NOT TO EXCEED
61
$30,000)__________________ Enter result on Line 61 ................................................
62
62.
Pension Benefit Guaranty Modification (see instructions) ...................................................
63.
Income received and includible in federal adjusted gross income but exempt from state
tax by federal law.
63
State the source and amount of exempt income.
64
64.
Refunds of state and local income taxes received and reported as income to the IRS ......
65.
Contributions to West Virginia Prepaid Tuition Trust/
65
West Virginia Savings Plan Trust Funds ............................................................................
66
66.
Other Deduction(s) i.e., Long-Term Care Insurance, WV Medical Savings Account ........
67.
Senior citizen or disability deduction (see instructions on pages 28 thru 30)
(a) Income from sources not included
YOU
SPOUSE
(a)
in lines 58 through 66 .............................
(b)
(b) Maximum modification .............................
$8,000 00
$8,000 00
(c)
(c) Add lines 58 through 61 above ...............
(d)
(d) Subtract line (c) from line (b) ...................
(If less than zero, enter zero)
Enter smaller of (a) or (d) .............................
67
68.
Surviving spouse deduction (use worksheet on page 30) ...................................................
68
69.
Combine lines 58 through 68 for each column ....................................................................
69
70.
TOTAL SUBTRACTIONS (line 69, Column A plus line 69, Column B). Enter on line 4 of Form IT-140NR/PY
70
If you are claiming a disability modification on line 67 or line 68, be sure to attach Schedule H to your return.
RESIDENCY
Nonresident - did not maintain a residence in West Virginia during the taxable year (NO CREDIT IS ALLOWED).
STATUS
Part-Year Resident - maintained a residence in West Virginia for part of the year;
check the box which describes your situation and enter the date of your move:
moved into West Virginia.
moved out of West Virginia, but had West Virginia source income during your nonresident period.
moved out of West Virginia and had no West Virginia source income during your nonresident period.
71
71.
Income tax computed on your 2002 __________________ return ....................................................................
NAME OF STATE
72
72.
West Virginia total income tax (line 11 of Form IT-140NR/PY) ............................................................................
73
73.
Net income derived from above state included in West Virginia total income .....................................................
74
74.
Total West Virginia income (line 50 of Schedule A) .............................................................................................
75
75.
Limitation of credit (line 72 multiplied by line 73 and divided by line 74) ............................................................
76
76.
Alternative West Virginia taxable income (line 74 minus line 73) ........................................................................
77
77.
Alternative West Virginia total income tax (see instructions to calculate tax on the amount on line 76) .............
78
78.
Limitation of credit (line 72 minus line 77) ...........................................................................................................
79
79.
Maximum credit (line 72 minus line 14 of Form IT-140NR/PY) ...........................................................................
80
80.
Total credit (the SMALLEST of lines 71, 72, 75, 78, or 79). Enter on line 15 of your return ...............................
ATTACH A COPY OF THE OTHER STATE'S RETURN. FAILURE TO DO SO WILL RESULT IN THE CLAIMED
CREDIT BEING DISALLOWED. THIS CREDIT IS NOT ALLOWED IN ANY CASE FOR INCOME TAX IMPOSED BY
A CITY, TOWNSHIP, BOROUGH, OR ANY POLITICAL SUBDIVISION OF A STATE.
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