Schedule In-113 - Income Adjustment Calculations - 2012

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*121131199*
2012
Income Adjustment
SCHEDULE
113
IN-
Calculations
VERMONT
* 1 2 1 1 3 1 1 9 9 *
Nonresidents and Part-Year Residents Must Complete Parts I and II
Full-Year Residents with Adjustments Complete Part II only
Please PRINT in BLUE or BLACK INK
ATTACH TO FORM IN-111
Taxpayer’s Social Security Number
-
-
Taxpayer’s Last Name
First Name
Initial
PART I. Enter figures as they appear on your federal return or recomputed federal return in Column A and list the VT portion in
Column B. See instructions starting on page 12.
Month
Day
Year
Month
Day
Year
From
to
Dates of VT residency in 2012: . . . . . . . . . . .
Name of state(s), Canadian province or country during non-VT residency . . . . .
B. VT Portion $
A. Federal Amount $
.
.
0 0
0 0
1 . Wages, salaries, tips, etc. . . . . . . . . . . . . . . . . . . .1 .
1 .
.
.
0 0
0 0
2 . Taxable interest . . . . . . . . . . . . . . . . . . . . . . . . . . .2 .
2 .
.
.
0 0
0 0
3 . Ordinary dividends . . . . . . . . . . . . . . . . . . . . . . . .3 .
3 .
.
.
4 . Taxable refunds of state and local
0 0
0 0
4 .
income taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 .
.
.
0 0
0 0
5 . Alimony received . . . . . . . . . . . . . . . . . . . . . . . . .5 .
5 .
.
.
Check to
Check to
0 0
0 0
ç indicate
ç indicate
6 . Business income or loss . . . . . .
6 .
6 .
loss
loss
.
.
Check to
Check to
0 0
0 0
ç indicate
ç indicate
7 . Capital gain or loss . . . . . . . . . .
7 .
7 .
loss
loss
.
.
0 0
0 0
8 . Taxable IRA distributions . . . . . . . . . . . . . . . . . .8 .
8 .
.
.
0 0
0 0
9 . Taxable pensions and annuities . . . . . . . . . . . . . .9 .
9 .
.
.
Check to
Check to
10 . Partnerships/S Corporations,
0 0
0 0
ç indicate
ç indicate
and LLCs . . . . . . . . . . . . . . . . .
10 .
10 .
loss
loss
.
.
Check to
Check to
11 . Rents, royalties, estates,
0 0
0 0
ç indicate
ç indicate
trusts, etc. . . . . . . . . . . . . . . . . .
11 .
11 .
loss
loss
.
.
Check to
Check to
0 0
0 0
ç indicate
ç indicate
12 . Farm income or loss . . . . . . . . .
12 .
12 .
loss
loss
.
.
0 0
0 0
13 . Unemployment compensation . . . . . . . . . . . . . .13 .
13 .
.
.
0 0
0 0
14 . Taxable social security . . . . . . . . . . . . . . . . . . . .14 .
14 .
.
.
Check to
Check to
0 0
0 0
ç indicate
ç indicate
15 . Other: Specify____________ . .
15 .
15 .
loss
loss
(See instructions on page 13)
.
.
Check to
16 . TOTAL INCOME
0 0
Check to
0 0
ç indicate
ç indicate
(Add Lines 1–15) . . . . . . . . . . .
16 .
16 .
loss
loss
Please be sure to print your name and Social Security number at the top of this page.
continued on back
21
Schedule IN-113

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