Long Form - Deductions Applicable To Individual Taxpayers

Long Form - Deductions Applicable To Individual Taxpayers - 2012 Page 2

Schedule A Individual (Long Form) - Page 2

Rev. Feb 19 13

Taxpayer's name

Social Security Number

Part III

Medical Expenses and Charitable Contributions

(D) Contributions to

Employer Identificación

(B) Other Contributions

(A) Medical Expenses

Easement and

Name of person or institution to whom payment was made

Municipalities

Number

Museological Institutions

(04)

(07)

(10)

Total Columns A, B, C and D ………………………………...…......…

(01)

Multiply the adjusted gross income (Part 1, line 5 of the

return or line 6, Columns B and C of Schedule CO Individual) by 6%

and enter here (See instructions) .......................................................

(02)

Allowable deduction for medical expenses (Subtract line 2 from

line 1. Enter here and in Part I, line 3 of this Schedule or on

Schedule CO Individual, line 7C) ….......................................

(03)

Multiply the adjusted gross income (Part 1, line 5 of the return or line 6, Columns B and C of

Schedule CO Individual) by 50% and enter here (See instructions) ...............

( 0 5 )

Deduction for other contributions (Enter the smaller of lines 1B and 4) ….....……......….....

( 0 6 )

Multiply the adjusted gross income (Part 1, line 5 of the return or line 6, Columns B and C of Schedule CO Individual)

by 30% and enter here (See instructions) ………...............................................................................................….....….

(08)

Deduction for contributions to Conservation Easements and Museological Institutions (Enter the smaller of lines 1C and 6) ..

(09)

Total allowable deductions for contributions (Add lines 1D, 5 and 7. Enter here and in Part I, line 4 of this Schedule or on Schedule CO

Individual, line 7D) ........................................................................................................................................................................................…

(11)

Retention Period: Ten (10) years

Long Form - Deductions Applicable To Individual Taxpayers - 2012 Page 2

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