Form Nr - Delaware Individual Non-Resident Income Tax Return - 2003 Page 2

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2003 DELAWARE NON-RESIDENT FORM 200-02, PAGE 2
Delaware Source
Federal
Income/Loss
COLUMN 1
SECTION A - INCOME AND ADJUSTMENTS FROM FEDERAL RETURN
COLUMN 2
00
00
1.
Wages, salaries, tips, etc. . .................................................................................................................... 1
Interest.................................................................................................................................................. 2
00
00
2.
3.
Dividends.............................................................................................................................................. 3
00
00
4.
State refunds, credits or offsets of state & local income taxes............................................................ 4
00
00
5.
Alimony received.................................................................................................................................. 5
00
00
00
00
6.
Business income or (loss) (See instructions)....................................................................................... 6
00
00
7a.
Capital gain or (loss) . ............................................................................................................................7a
7b.
Other gains or (losses)........................................................................................................................ 7b
00
00
8.
IRA distributions................................................................................................................ . .................. 8
00
00
9.
Taxable pensions and annuities.......................................................................................................... 9
00
00
00
00
10.
Rents, royalties, partnerships, S corps, estates, trusts, etc................................................................ 10
00
00
11.
Farm income or (loss)......................................................................................................................... 11
12.
Unemployment compensation (insurance)......................................................................................... 12
00
00
13.
Taxable Social Security Benefits........................................................................................................ 13
00
00
14.
Other income (state nature and source)
00
00
14
Total income. Add Lines 1 through 14............................................................................................... 15
00
00
15.
Total Federal Adjustments (See instructions).................................................................................... 16
00
00
16.
17.
Federal Adjusted Gross Income for Delaware purposes. Subtract Line 16 from 15......................... 17
00
00
SECTION B - DELAWARE MODIFICATIONS AND ADJUSTMENTS - ADDITIONS ( + )
COLUMN 1
COLUMN 2
18.
Interest received on obligations of any state other than Delaware..................................................... 18
00
00
19.
Fiduciary adjustment, oil depletion...................................................................................................... 19
00
00
00
00
20.
TOTAL - Add Lines 18 & 19................................................................................................................ 20
00
00
21.
Add Lines 17 & 20............................................................................................................................... 21
SECTION C - DELAWARE MODIFICATIONS AND ADJUSTMENTS - SUBTRACTIONS ( - )
COLUMN 1
COLUMN 2
00
00
22.
Interest received on U.S. Obligations.................................................................................................. 22
23.
Pension Exclusion/Retirement Exclusion (See instructions)............................................................... 23
00
00
24.
Delaware State tax refund, Delaware Lottery...................................................................................... 24
00
00
25.
Fiduciary Adjustment, Work Opportunity Credit, Delaware NOL Carryforward................................... 25
00
00
00
00
26.
Taxable Social Security Benefits/Railroad Retirement Benefits/Higher Education Exclusion. . ........... 26
00
00
27.
TOTAL - Add Lines 22 through 26...................................................................................................... 27
Subtract Line 27 from Line 21 and enter here.................................................................................... 28
28.
00
00
29.
Exclusion for certain persons 60 and over or disabled (See instructions).......................................... 29
00
00
30A. Column 2. Subtract Line 29 from Line 28. This is your modified Delaware Source Income.
00
Enter on front side Line 42, Box A....................................................................................................................................... 30A
30B. Column 1. Subtract Line 29 from Line 28. This is your Delaware Adjusted Gross Income.
00
Enter on front side Line 37 and Line 42, Box B............................................................................ 30B
SECTION D - ITEMIZED DEDUCTIONS (ATTACH FEDERAL SCHEDULE A, FORM 1040)
COLUMN 1
00
31.
Enter total Itemized Deductions (See instructions)............................................................................. 31
32.
Enter Foreign Taxes Paid (See instructions)...................................................................................... 32
00
33.
Enter Charitable Mileage Deduction (See instructions)...................................................................... 33
00
00
34.
TOTAL - Add Lines 31, 32, and 33 ................................................................................................... . 34
00
35a. Enter State Income Tax included in Line 31 above (See Instructions)............................................... 35a
00
35b. Enter Form 700 Tax Credit Adjustment (See instructions)................................................................. 35b
00
36.
Subtract Line 35a and 35b from Line 34. Enter here and on front, Line 38....................................... 36
.
SECTION E - DIRECT DEPOSIT INFORMATION
If you would like your refund deposited directly
to your checking or savings account, complete boxes a, b and c below. See instructions for details.
a. Routing Number
b. Type:
Checking
Savings
DATE OF DEATH
SPOUSE
TAXPAYER
c. Account Number
/
/
/
/
Month Day Year
Month Day Year
NET BALANCE DUE (LINE 57):
NET REFUND (LINE 58):
ZERO (LINE 58):
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
P.O. BOX 8752
P.O. BOX 8772
P.O. BOX 8711
WILMINGTON, DE 19899-8752
WILMINGTON, DE 19899-8772
WILMINGTON, DE 19899-8711
MAKE CHECKS PAYABLE TO: DELAWARE DIVISION OF REVENUE
REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN
AND KEEP A COPY OF THE RETURN FOR YOUR RECORDS.
(Rev. 9/11/03)

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