Form 43 Draft - Idaho Part-Year Resident & Nonresident Income Tax Return - 2014
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1
28734
F
43
2014
O
IDAHO PART-YEAR RESIDENT & NONRESIDENT INCOME TAX RETURN
R
M
EFO00091 06-13-14v4
.
State Use Only
No Change-p1
AMENDED RETURN, check the box.
.
06-19-14
See instructions, page 12 for the reasons
for amending and enter the number.
,
For calendar year 2014, or fiscal year beginning
ending
Your Social Security Number (required)
Your first name and initial
Last name
Deceased
in 2014
Spouse's first name and initial
Last name
Spouse's Social Security Number (required)
Deceased
Mailing address
in 2014
Do you need Idaho income tax forms mailed to you next year?
.
.
City, State, and Zip Code
Yes
No
.
If you or your spouse are nonresident aliens for federal purposes, check here.
Forms also available at tax.idaho.gov
. .
. .
. .
. .
. .
Resident
Idaho Resident on Active Military Duty
Nonresident
Part-Year Resident
Military Nonresident
Residency status
Yourself
Check one for yourself and one for
1
2
3
4
5
your spouse if a joint return.
Spouse
.
.
.
.
Indicate current state of residence.
Yourself _____
Spouse _____
Full months in Idaho this year
Yourself _____
Spouse _____
FILING STATUS.
Check only one box.
6. EXEMPTIONS.
Yourself a.
I
f someone can claim you as a
Enter "1" in boxes 6a,
If filing married joint or separate return, enter
dependent, leave box 6a blank.
and 6b, if they apply.
Spouse
b.
spouse's name and Social Security Number above.
c. List your dependents. If more than four dependents, continue on Form 39NR.
1.
Single
Enter the total number here ................................................................................ c.
2.
Married filing jointly
First name
Last name
Social Security Number
___________________________________________________________________
___________________________________________________________________
3.
Married filing separately
___________________________________________________________________
4.
Head of household
___________________________________________________________________
5.
Qualifying widow(er)
___________________________________________________________________
d. Total exemptions. Add lines 6a through 6c. Must match federal return ............ d.
.
Idaho Amounts
IDAHO INCOME. See instructions, page 13.
.
00
7. Wages, salaries, tips, etc. Include Form(s) W-2 ..................................................................................................
7
00
8. Taxable interest income ........................................................................................................................................
.
8
.
00
9. Dividend income ...................................................................................................................................................
9
10. Alimony received ..................................................................................................................................................
.
00
10
00
11. Business income or (loss). Include federal Schedule C or C-EZ ........................................................................
.
11
00
12. Capital gain or (loss). If required, include federal Schedule D ............................................................................
.
12
13. Other gains or (losses). Include federal Form 4797 ............................................................................................
.
00
13
.
00
14. IRA distributions (taxable amount) ......................................................................................................................
14
00
15. Pensions and annuities (taxable amount) ............................................................................................................
.
15
00
16. Rents, royalties, partnerships, S corporations, trusts, etc. Include federal Schedule E ......................................
.
16
00
17. Farm income or (loss). Include federal Schedule F .............................................................................................
.
17
00
18. Unemployment compensation ..............................................................................................................................
.
18
00
19. Other income. Include explanation ......................................................................................................................
19
20. TOTAL INCOME. Add lines 7 through 19 ............................................................................................................
00
20
IDAHO ADJUSTMENTS. See instructions, page 13.
.
21. Deductions for IRAs, health savings accounts, and IRC 501(c)(18)(D) retirement plan ......................................
00
.
21
22. Tuition and fees, moving expenses, alimony paid, and student loan interest ......................................................
.
22
00
23. Deductions for self-employment tax, health insurance, and qualified retirement plans ........................................
.
00
23
24. Penalty on early withdrawal of savings ................................................................................................................
.
00
24
25. Other deductions. See instructions .....................................................................................................................
00
25
26. TOTAL ADJUSTMENTS. Add lines 21 through 25 .............................................................................................
00
26
.
27. ADJUSTED GROSS INCOME. Subtract line 26 from line 20 ..............................................................................
00
27
.
Within 180 days of receiving this return, the Idaho State Tax Commission may discuss this return with the paid preparer identified below.
Under penalties of perjury, I declare that to the best of my knowledge and belief this return is true, correct, and complete. See instructions.
.
Your signature
Date
MAIL TO: Idaho State Tax Commission, PO Box 56, Boise, ID 83756-0056
SIGN
INCLUDE A COMPLETE
.
HERE
Spouse's signature (if a joint return, BOTH MUST SIGN)
Daytime phone
{"Jg¦}
COPY OF YOUR
.
.
FEDERAL RETURN.
Paid preparer's signature
Preparer's EIN, SSN, or PTIN
Address and phone number
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