Form 200-02-X - Non-Resident Amended Delaware Personal Income Tax Return

FORM 200-02-X - NON-RESIDENT AMENDED DELAWARE PERSONAL INCOME TAX RETURN - TAX YEAR 2011

Page 2

NOTE: IF YOUR ORIGINAL RETURN WAS FILED USING TWO SEPARATE FORMS, YOU MUST FILE TWO SEPARATE AMENDED FORMS

IS AN AMENDED FEDERAL

RETURN BEING FILED?...................................................................................................................

YES

IF NO, PLEASE EXPLAIN. IF THE CHANGES PERTAIN TO THE DE RETURN ONLY, LIST THE LINE NUMBERS BEING AMENDED.

HAS THE DELAWARE DIVISION OF REVENUE ADVISED YOU YOUR ORIGINAL RETURN IS BEING AUDITED?...........................

YES

IS THIS AMENDED RETURN BEING FILED AS A PROTECTIVE CLAIM?.........................................................................................

YES

A DETAILED EXPLANATION OF ALL CHANGES MUST BE PROVIDED IN THIS SPACE. ALL SUPPORTING SCHEDULES AND/OR DOCUMENTATION MUST BE ATTACHED.

Federal

DE SourceIncome/Loss

SECTION A - INCOME AND ADJUSTMENTS FROM FEDERAL RETURN

COLUMN 1

COLUMN 2

27.

Wages, salaries, tips, etc................................................................................................................................

28.

Interest.............................................................................................................................................................

29.

Dividends.........................................................................................................................................................

30.

State refunds, credits or o sets of state & local income taxes.................................................................

31.

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

32.

Business income or (loss) (See instructions)...............................................................................................

33a. Capital gain or (loss)......................................................................................................................................

33a

33b. Other gains or (losses)...................................................................................................................................

33b

34.

IRA distributions............................................................................................................................................

35.

Taxable pensions and annuities...................................................................................................................

36.

Rents, royalties, partnerships, S corps, estates, trusts, etc.......................................................................

37.

Farm income or (loss)....................................................................................................................................

38.

Unemployment compensation (insurance).................................................................................................

39.

Taxable Social Security Bene ts...................................................................................................................

40.

Other income (state nature and source)

41.

Total income. Add Lines 27 through 40......................................................................................................

42.

Total Federal Adjustments (See instructions)............................................................................................

43.

Federal Adjusted Gross Income for Delaware purposes. Subtract Line 42 from 41...............................

SECTION B - DELAWARE MODIFICATIONS AND ADJUSTMENTS - ADDITIONS ( + )

COLUMN 1

COLUMN 2

44.

Interest received on obligations of any state other than Delaware........................................................

45.

Fiduciary adjustment, oil depletion............................................................................................................

46.

TOTAL - Add Lines 44 & 45...........................................................................................................................

47.

Add Lines 43 & 46..........................................................................................................................................

SECTION C - DELAWARE MODIFICATIONS AND ADJUSTMENTS - SUBTRACTIONS ( - )

COLUMN 1

COLUMN 2

48.

Interest received on U.S. Obligations..........................................................................................................

49.

Pension/Retirement Exclusions

(See instructions)

..................................................................................

50.

Delaware State t ax refund . ................................. . ........................... . .................................................................

51.

Fiduciary Adjustment, Work Oppor tunity Credit, Delaware NOL Carryforward.....................................

52.

Taxable Social Security Bene ts/Railroad Retirement Bene ts/Higher Education Exclusion...............

53.

TOTAL - Add Lines 48 through 52................................................................................................................

54.

Subtract Line 53 from Line 47 and enter here............................................................................................

55.

Exclusion for certain persons 60 and over or disabled (See instructions)..............................................

Column 2. Subtract Line 55 from Line 54. This is your modi ed Delaware Source Income.

56A.

56A

Enter on front side Line 6, Box A

........................................................................................................................................................

Column 1. Subtract Line 55 from Line 54. This is your Delaware Adjusted Gross Income.

56B.

56B

Enter on front side Line 1 and Line 6, Box B .

..........................................................................................

COLUMN 1

SECTION D - ITEMIZED DEDUCTIONS (ATTACH FEDERAL SCHEDULE A, FORM 1040)

57. Enter total Itemized Deductions

(If Filing Status 3, see instructions)

....................................................

58. Enter Foreign Taxes Paid (See instructions)................................................................................................

59. Enter Charitable Mileage Deduction (See instructions).............................................................................

60. TOTAL - Add Lines 57, 58, and 59 ................................................................................................................

61a. Enter State Income Tax included in Line 57 above (See Instructions)....................................................

61a

61b. Enter Form 700 Tax Credit Adjustment (See instructions)........................................................................

61b

62.

Subtract Line 61a and 61b from Line 60. Enter here and on front, Line 2..............................................

Toll-free telephone number (Delaware only) 1-800-292-7826

(Rev 11/22/11)

Form 200-02-X - Non-Resident Amended Delaware Personal Income Tax Return - 2011 Page 2

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