Form 40nr - Alabama Individual Nonresident Income Tax Return - 2012 Page 2

1200024N1283

Page 2

Form 40NR (2012)

P RT I

B — All Sources

C — Alabama Sources

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1 Interest and dividend income (attach Schedule B if over $1500.00) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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1

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2 Alimony received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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3 Taxable portion of pensions and annuities (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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4 Business income or (loss) (attach Federal Schedule C) (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Other

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5 Gain or (loss) from sale of Real Estate, Stocks, Bonds, etc. (attach Schedule D). . . . . . . . . . . . . . . . . . . . . .

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Income

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6 Rents, Royalties, Partnerships, Estates, Trusts, etc. (attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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6

(See page 11)

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7 Farm income or (loss) (attach Federal Schedule F) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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7

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8 Other income (state nature and source)

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9 Total other income. Add lines 1 through 8, column B, and lines 1, 4 through 8, column C.

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Enter here and also on page 1, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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9

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P RT II

1 IRA deduction, Keogh retirement plan, and self-employed SEP deduction . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

1

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2 Penalty on early withdrawal of savings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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3 Moving Expenses (Attach Federal Form 3903) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Adjustments

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Place of new employment: City ______________________________ State _______ ZIP ___________

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to Income

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4 Self-employed health insurance deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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4

(See page 12)

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5 Payments to Alabama PACT program or Alabama College Education Savings Program . . . . . . . . . . . . . . .

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5

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6 Add lines 1 through 5. Enter here and also on page 1, line 8, columns B and C . . . . . . . . . . . . . . . . . . . . . . .

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P RT III

1 Alimony Paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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2 Adoption Expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Other

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3 Health insurance deduction for small employer employee (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . .

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Adjustments

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4 Add lines 1 through 3, enter here and on page 1, line 11, column B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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(See page 13)

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5 Enter percentage from page 1, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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6 Multiply line 4 by line 5. Enter here and also page 1, line 11, column C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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P RT IV

If you are filing separately on your Alabama return and jointly on your Federal return, complete all lines

B — Federal Adjusted

C — Alabama Federal

Gross Income

Tax Deduction Computation

below. Otherwise, omit lines 1 through 3.

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1 Your joint federal adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Federal

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2 Your federal adjusted gross income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Income Tax

3 Divide line 2 by line 1. Enter percentage here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

%

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Deduction

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4 Enter Federal Income Tax Liability from worksheet (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4

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(See page 13)

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5 If you completed lines 1 through 3 above, multiply line 4 by the percentage from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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6 Enter percentage from page 1, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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7 If you completed lines 1 through 3 above, multiply line 5 by the percentage on line 6. Otherwise multiply line 4 by the percentage on line 6. .

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P RT V

See instructions for definition of a dependent. NOTE: If you checked filing status 3 (Married filing separate return), you may claim only the dependent(s) for whom you

separately furnished over 50% of the total support.

1a

(4) Did you provide

Dependents:

(2) Dependent’s

(3) Dependent’s rela-

more than one-half

(1) First name

Last name

social security number.

tionship to you.

Dependents

dependent's support?

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Do not include

yourself or

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your spouse

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b Total number of dependents claimed above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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(See page 13)

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2 Multiply the total number of dependents claimed on line 1b by the amount from the dependent chart on page 9 of instructions. . . . . . . . . . . . .

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3 Enter percentage from page 1, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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4 Dependent exemption allowable. Multiply the amount on line 2 by the percentage on line 3. Enter here and on page 1, line 16. . . . . . . . . . .

P RT VI

1 Name of state of which you were a legal resident in 2012

2 Did you file a return with that state for 2012?

Yes

No If no, state reason why:

3 If married, did your spouse receive a separate income for 2012?

Yes

No

If yes, is your spouse filing a separate Alabama return?

Yes

No

General

If yes, enter name here.

Information

4 Did you file an Alabama return for 2011?

Yes

No If no, state reason why:

5 Give name and address of your present employer(s). Yours:

All Taxpayers

Must Complete

Your Spouse’s:

This Section

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6 Enter the Adjusted Gross Income reported on your 2012 Federal Individual Income Tax Return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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7 If you are a shareholder or partner in an Alabama S Corporation or Partnership which filed the Alabama Form PTE-C, complete the following information:

(See page 14)

S Corporation’s/Partnership’s name

FEIN

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Amount of payment made by the S Corporation or Partnership on your behalf on the PTE-C Composite Return. . . . . . . . . . . . . . . . . . . . . . . . . .

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Enter here and on page 1, line 23.

MAIL FORM 40NR TO:

Alabama Department of Revenue, P.O. Box 327469, Montgomery, AL 36132-7469

ADOR