Form 1040xn - Amended Nebraska Individual Income Tax Return - 2011 Page 3

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FORM 1040XN

NEBRASKA SCHEDULE I — Nebraska Adjustments to Income

Schedules

NEBRASKA SCHEDULE II — Credit for Tax Paid to Another State

I, II, and III

NEBRASKA SCHEDULE III — Computation of Nebraska Tax

2011

Name on Form 1040XN

Social Security Number

Nebraska Schedule I — Nebraska Adjustments to Income

for Nebraska Residents, Nonresidents, and Partial-Year Residents

PART A — Adjustments Increasing Federal Adjusted Gross Income (AGI)

48 Total adjustments increasing income (include interest from non-Nebraska state and local obligations) .

Correct Amount

Enter here and on line 12 of Form 1040XN . List the items being changed ____________________________

______________________________________________________________________________________ 48

PART B — Adjustments Decreasing Federal AGI

49 State income tax refund deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

50 Interest or dividend income from U .S . obligations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

51 Taxable Tier I and/or Tier II benefits paid by the Railroad Retirement Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

52 Special capital gains/extraordinary dividends deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

53 Nebraska College Savings Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

54 Nebraska Long-Term Care Savings Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

55 Other adjustments decreasing Federal AGI (see instructions) . List adjustments being changed . ___________

______________________________________________________________________________________ 55

56 Total adjustments decreasing Federal AGI (add lines 49 through 55) . Enter here and on line 13, Form 1040XN 56

Nebraska Schedule II — Credit for Tax Paid to Another State for Full-Year Residents Only

If line 58 or 60 is amended, a copy of the return filed with another state must be attached.

Correct Amount

57 Total Nebraska tax (line 17, Form 1040XN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

58 AGI from another state (do not enter amount of taxable income from the other state) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

59 Calculated tax credit:

Line 58

x Line 57

Line 5 + Line 12 - Line 13 =

60 Tax due and paid to another state (do not enter amount withheld for the other state) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

61 Maximum tax credit (line 57, 59, or 60, whichever is least) . Enter amount here and on line 20, Form 1040XN . . 61

Nebraska Schedule III — Computation of Nebraska Tax

Nonresidents and partial-year residents complete lines 62 through 74 below.

Correct Amount

62 Income derived from Nebraska sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

63 Adjustments as applied to Nebraska income . Refer to Form 1040N instructions and list the items being

changed _______________________________________________________________________________

64 Nebraska AGI (line 62 minus line 63) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

65 Ratio – Nebraska’s share of the total income (round to four decimal places):

Line 64

Line 5 + Line 12 - Line 13

66 Nebraska Taxable Income (from line 14, Form 1040XN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

67 Nebraska total income tax (see instructions):

. Enter difference here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

, minus credits: $

68 Enter personal exemption credit (if any) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

69 Difference (line 67 minus line 68) (if less than zero, enter -0-) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

70 Nebraska share of line 69 (multiply line 69 by line 65 ratio) . Enter here and on line 15, Form 1040XN . . . . . . . . . . . . . . 70

71 Nebraska minimum and other taxes (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

72 Nebraska share of line 71 . Subtract any unused personal exemption credit from line 68 .

Multiply the result by the line 65 ratio . Enter here and on line 16, Form 1040XN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

73 Earned income credit (Partial-year residents only)

Number of qualifying children

. Federal earned income credit

x .10 (10%) . . . . . . . . . . .

74 Partial-year residents, multiply line 73 by line 65 ratio . Enter here and on line 33, Form 1040XN . . . . . . . . . . . . . . . . . . . . . .