Form 200-03 Ez - Delaware Individual Resident Income Tax - 1999

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1999
DELAWARE INDIVIDUAL RESIDENT
DO NOT WRITE OR STAPLE IN THIS AREA
EZ
INCOME TAX FORM
FORM 200-03 EZ
Your Social Security No.
Spouse's Social Security No.
FILING STATUS (MUST CHECK ONE)
(Attach Label Here)
1.
Single Divorced,
2.
Joint
5.
Head of
Widow(er)
Household
If you were a part-year resident in 1999, give the dates you resided in
Last Name
Your First Name and Middle Initial
Suffix
Delaware.
From
To
1999
1999
Spouse's Last Name
Spouse's First Name
Suffix
Month
Day
Month
Day
Present Home Address (Number and Street)
Apt.#
City
State
Zip Code
CHECK IF: YOU WERE 65 OR OVER
BLIND
CHECK IF: SPOUSE WAS 65 OR OVER
BLIND
DO NOT
ENTER CENTS
1.
Enter amount from Federal Return (see back). ............................................................................ 1.
00
00
2.
Pension Exclusion (see instructions).
......................................................................................... 2.
00
3.
Delaware Adjusted Gross Income (subtract Line 2 from Line 1). ................................................. 3.
4.
Standard Deduction:
Filing Statuses 1 & 5 Enter $3,250
00
Filing Status 2 Enter $4,000 .................................................................... 4.
00
5.
ADDITIONAL STANDARD DEDUCTION FROM WORKSHEET, Page 2..................................... 5.
00
6.
Add Lines 4 and 5.......................................................................................................................... 6.
7.
Subtract Line 6 from Line 3: This is your Taxable Income.
00
Compute Tax on this Amount or Use the Tax Table. .................................................................... 7.
00
8.
Tax Liability from Tax Table/Schedule........................................................................................... 8.
9a. Enter number of exemptions claimed on Federal return.
x $100. ................................... 9a.
00
9b. CHECK BOX(ES): If you were 60 or over
Spouse was 60 or over (filing status 2)
Enter number of boxes checked
x 100. ........................................................................ 9b.
00
10. TOTAL Non-Refundable Credit. Add Lines 9a & 9b and enter here. ........................................... 10.
00
00
11. BALANCE (Subtract Line 10 from Line 8. Cannot be less than ZERO). .................................... 11.
00
12. Delaware Tax Withheld (W-2's/1099's required). ........................................................................ 12.
00
13. 1999 Estimated Tax and Extension Payments.
.......................................................................... 13.
00
14. TOTAL Refundable Credits. Add Lines 12 and 13 and enter here.
............................................ 14.
15. If the amount on Line 11 is more than Line 14,
00
subtract Line 14 from Line 11; or ...................................................................BALANCE DUE> 15.
16. If the amount on Line 14 is more than Line 11,
00
subtract Line 11 from Line 14. .....................................................................OVERPAYMENT>
16.
17. Contributions to Special Funds:
D. Children’s Trust
00
A. Non-Game Wildlife
00
E. Breast Cancer Educ.
00
B. U.S. Olympics
00
F.
Organ Donations
00
C. Emergency Housing
00
00
Add Lines 17A thru F and enter here
17.
00
18. Amount of Line 16 to be credited to 2000 Estimated Tax Account . . . . . . . . . . . . . . . . . . . . . .
18.
00
19. NET BALANCE DUE. Add Lines 15 and 17; or . . . . . . . . . . . . . . . . . . . . . . . . . . .Pay In Full >
19.
20. NET REFUND. Subtract Lines 17 and 18 from Line 16.................To Be Refunded/Zero Due >
20.
00
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements,
and, to the best of my knowledge and belief, it is true, correct and complete.
Your Signature
Date
Signature of Paid Preparer
Date
Spouse Signature
Date
Address-Zip Code
Home Phone
Business Phone
Business Phone
EIN, SSN, or PTIN
DELAWARE RESIDENT EZ
(REV. 10/99)

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