Form 200-01 - Delaware Individual Resident Income Tax Return - 2009 Page 2

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2009 DELAWARE RESIDENT FORM 200-01, PAGE 2
COLUMNS:
Column A is reserved for the spouse of those couples choosing filing status 4.
(Reconcile your Federal totals to the
appropriate individual. See Page 9 worksheet.) Taxpayers using filing statuses 1, 2, 3, or 5 are to complete Column B only.
Filing Status 4 ONLY
All other filings statuses
Spouse Information
You or You plus Spouse
MODIFICATIONS TO FEDERAL ADJUSTED GROSS INCOME
COLUMN A
COLUMN B
SECTION A - ADDITIONS (+)
28
00
00
28.
Enter Federal AGI amount from Federal 1040, Line 37; 1040A, Line 21; or 1040EZ, Line 4
...........................
00
00
29. Interest on State & Local obligations other than Delaware..................................................................
29
00
00
30. Fiduciary adjustment, oil depletion....................................................................................................
30
00
00
31. TOTAL - Add Lines 29 and 30..........................................................................................................
31
32. Subtotal. Add Lines 28 and 31..........................
00
00
32
SECTION B - SUBTRACTIONS (-)
00
00
33
33. Interest received on U.S. Obligations................................................................................................
00
00
34. Pension/Retirement Exclusions
(For a definition of eligible income, see instructions on Page
10)...
34
35. Delaware State tax refund, Delaware Lottery, fiduciary adjustment, work opportunity tax credit,
00
00
Travelink Program, Delaware NOL Carry forward.- please see instructions on Page 10.........................
35
00
00
36
36.
Taxable Soc Sec/RR Retirement Benefits/Higher Educ. Excl/Certain Lump Sum Dist. (See instr. on Pg 11)...
00
00
37
37. SUBTOTAL. Add Lines 33, 34, 35 and 36 and enter here..................................................................
00
00
38
38. Subtotal. Subtract Line 37 from Line 32............
00
00
39
39. Exclusion for certain persons 60 and over or disabled (See instructions on Page 11)...........................
00
00
40
40. TOTAL - Add Lines 37 and 39..........................................................................................................
00
00
41
41.
DELAWARE ADJUSTED GROSS INCOME. Subtract line 40 from Line 32. Enter here and on Front, Line 1....
SECTION C - ITEMIZED DEDUCTIONS (MUST ATTACH FEDERAL SCHEDULE A)
If Columns A and B are used and you are unable to specifically
allocate deductions between spouses, you must prorate in accordance with income.
00
00
42
42. Enter total Itemized Deductions from Schedule A, Federal Form 1040, Line 29..................................
00
00
43
43. Enter Foreign Taxes Paid (See instructions on Page 11).....................................................................
00
00
44
44. Enter Charitable Mileage Deduction (See instructions on Page 11)......................................................
00
00
45
45. SUBTOTAL. - Add Lines 42, 43, and 44 and enter here.....................................................................
00
00
46a
46a. Enter State Income Tax included in Line 42 above (See instructions on Page 11).................................
00
00
46b
46b. Enter Form 700 Tax Credit Adjustment (See instructions on Page 11).................................................
00
00
47
47.
TOTAL - Subtract Line 46a and 46b from Line 45. Enter here and on Front, Line 2 (See instructions)...........
SECTION D - DIRECT DEPOSIT INFORMATION If you would like your refund deposited directly
to your checking or savings account, complete boxes a, b, c and d below. See instructions for details.
DATE OF DEATH
Column A
Column B
a. Routing Number
b. Type:
Checking
Savings
SPOUSE
TAXPAYER
/
/
/
/
c. Account Number
Month
Day
Year
Month
Day
Year
d. Is this refund going to or through an account that is located outside of the United States?
Yes
No
NOTE: If your refund is adjusted by $100.00 or more, a paper check will be issued and mailed to the address on your return.
BE SURE TO SIGN YOUR RETURN BELOW AND KEEP A COPY FOR YOUR RECORDS
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and believe it is true, correct and complete.
Your Signature
Date
Signature of Paid Preparer
Date
Spouse's Signature (if filing joint or combined return) Date
Address-Zip Code
Home Phone
Business Phone
Business Phone
EIN, SSN OR PTIN
E-Mail Address
E-Mail Address
NET BALANCE DUE (LINE 26):
NET REFUND (LINE 27):
ZERO (LINE 27):
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
P.O. BOX 508
P.O. BOX 8765
P.O. BOX 8711
WILMINGTON, DE 19899-0508
WILMINGTON, DE 19899-8765
WILMINGTON, DE 19899-8711
MAKE CHECK PAYABLE TO : DELAWARE DIVISION OF REVENUE
PLEASE REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING YOUR RETURN
(Rev 10/21/09)

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