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Explanation of adjustments made —Show the computations in detail. Attach applicable schedules.
I authorize the Department of
Under penalties for false swearing, I declare that I have examined this return, including accompanying schedules
Revenue to discuss this return
and statements. To the best of my knowledge and belief it is true, correct, and complete. If prepared by a person
with this preparer.
other than the taxpayer, this declaration is based on all information of which the preparer has any knowledge.
Signature of preparer other than taxpayer
(If filing jointly, BOTH must sign)
150-101-046 (Rev. 12-02)