Form 200-02 - Delaware Individual Non-Resident Income Tax Return - 2016 Page 2

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2016 NR
Page 2
2016 DELAWARE NON-RESIDENT FORM 200-02, PAGE 2
*DF20316029999*
Delaware Source
Federal
Income/Loss
DF20316029999
COLUMN 1
SECTION A - INCOME AND ADJUSTMENTS FROM FEDERAL RETURN
COLUMN 2
Wages, salaries, tips, etc.
1.
1
.............................................................................................................................................................
00
00
Interest
2.
..............................................................................................................................................................................................
2
00
00
Dividends
..........................................................................................................................................................................................
3.
3
00
00
State refunds, credits or offsets of state & local income taxes
4.
..............................................................................................
4
00
00
Alimony received
5
.............................................................................................................................................................................
5.
00
00
Business income or (loss) (See instructions on page 6)
6.
6
........................................................................................................
00
00
Capital gain or (loss)
7a
......................................................................................................................................................................
00
00
7a.
Other gains or (losses)
7b.
..................................................................................................................................................................
7b
00
00
IRA distributions
8.
..............................................................................................................................................................................
8
00
00
Taxable pensions and annuities
..................................................................................................................................................
9.
9
00
00
Rents, royalties, partnerships, S corps, estates, trusts, etc.
.................................................................................................
10.
10
00
00
Farm income or (loss)
...................................................................................................................................................................
11.
11
00
00
Unemployment compensation (insurance)
...............................................................................................................................
12.
12
00
00
Taxable Social Security benefits
13.
.................................................................................................................................................
13
00
00
Other income (state nature and source)
14.
14
00
00
Total income. Add Lines 1 through 14
15.
15
.......................................................................................................................................
00
00
Total Federal Adjustments (see instructions on Page 6)
16.
.......................................................................................................
16
00
00
Federal Adjusted Gross Income for Delaware purposes. Subract Line 16 from 15
17.
........................................................
17
00
00
COLUMN 1
COLUMN 2
SECTION B - DELAWARE MODIFICATIONS AND ADJUSTMENTS - ADDITIONS ( + )
Interest received on obligations of any state other than Delaware
18.
18
.....................................................................................
00
00
Fiduciary adjustment, oil depletion
19.
............................................................................................................................................
00
00
19
TOTAL - Add Lines 18 & 19
20.
.........................................................................................................................................................
20
00
00
Add Lines 17 & 20
21.
.........................................................................................................................................................................
21
00
00
COLUMN 1
COLUMN 2
SECTION C - DELAWARE MODIFICATIONS AND ADJUSTMENTS - SUBTRACTIONS (-)
22.
Interest received on U.S. obligations
22
00
00
..........................................................................................................................................
Pension/Retirement Exclusions
23.
00
00
(For a definition of eligible income, see instructions on Page 7)...............
23
24.
Delaware State tax refund
00
00
............................................................................................................................................................
24
Fiduciary Adjustment, Work Opportunity Credit, Delaware NOL Carryforward
00
00
25.
................................................................
25
Taxable Social Security Benefits/Railroad Retirement Benefits/Higher Education Exclusion
.........................................
26
00
00
26.
TOTAL - Add lines 22 through 26
27
00
00
27.
................................................................................................................................................
Subtract Line 27 from Line 21 and enter here
28
..........................................................................................................................
00
00
28.
29
Exclusion for certain persons 60 and over or disabled (see instructions on Page 8)
00
00
29.
.......................................................
Column 2. Subtract Line 29 from Line 28. This is your modified Delaware Source Income......................................
30A
30A
00
Enter on front side Line 42, Box A
..........................................................................................................................................
30B
Column 1. Subtract Line 29 from Line 28. This is your Delaware Adjusted Gross Income
............................................
30B
00
Enter on front side Line 37 and Line 42, Box B
..................................................................................................................
COLUMN 1
SECTION D - ITEMIZED DEDUCTIONS (ATTACH FEDERAL SCHEDULE A, FORM 1040)
Enter total Itemized Deductions (If Filing Status 3, See instructions on Page 8)
31.
31
........................................................
00
Enter Foreign Taxes Paid (See instructions on Page 8)
32.
........................................................................................................
00
32
Enter Charitable Mileage Deduction (See instructions on Page 8)
33.
......................................................................................
00
33
TOTAL - Add Lines 31, 32, and 33
34.
..............................................................................................................................................
34
00
35a
35a
Enter State Income Tax included in Line 31 above (see Instructions on Page 8) ..............................................................................
00
Enter Form 700 Tax Credit Adjustment (See instructions on Page 9)
35b
35b
00
.................................................................................
36
Subtract Line 35a and 35b from Line 34. Enter here and on front, Line 38
36.
00
.......................................................................
SECTION E - 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.
a. Routing Number
b. Type:
Checking
Savings
d. Is this refund going to or through an account that
is located outside of the United states?
c. Account Number
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.
BALANCE DUE W/PAYMENT ENCLOSED (LINE 58):
REFUND (LINE 59):
ALL OTHER RETURNS:
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
DELAWARE DIVISION OF REVENUE
P.O. BOX 508, WILMINGTON, DE 19899-0508
P.O. BOX 8710, WILMINGTON, DE 19899-8710
P.O. BOX 8711, WILMINGTON, DE 19899-8711
MAKE CHECK PAYABLE TO: DELAWARE DIVISION OF REVENUE. REMEMBER TO ATTACH APPROPRIATE SUPPORTING SCHEDULES WHEN FILING
YOUR RETURN, AND KEEP A COPY OF THE RETURN FOR YOUR RECORDS
(Rev 11/2016)

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