Form 765 - Unified Nonresidernt Individual Income Tax Return - 2016

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*VA0765116888*
2016 VIRGINIA
Unified Nonresident Individual
Income Tax Return
Form 765
Department of Taxation
(Composite Return)
P.O. Box 760
Richmond, VA 23218-0760
FISCAL or SHORT Year Filer: Beginning Date
For Qualified Owners of a Pass‑Through Entity (PTE)
Ending Date
Legal Name of Pass-Through Entity
Official Use Only
Check if -
Change In Address
Number and Street
Legal Name Change
Address Continued
FEIN
Amended Return
City or Town, State, and ZIP
Virginia Account Number
760C Enclosed
PART I : Participants’ Combined Income
1. Virginia Income (from Part II, Line 5). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
00
2. Total Additions (from Part II, Line 11, Column B). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
00
00
3. Subtotal. Add Line 1 and Line 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
00
4. Total Subtractions (from Part II, Line 17, Column B). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
00
5. Virginia Taxable Income. Subtract Line 4 from Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
00
6. Amount of Tax (Round to whole dollars). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
00
7. Estimated Tax paid for Taxable Year 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
00
8. Extension Payment (from Form 770IP). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
00
9. Total Credits (from attached Schedule CR). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
10. Total Payments and Credits. Add Lines 7, 8, and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
00
00
11. If Line 6 is greater than Line 10, enter the difference. This is the Income Tax You Owe. . . . . . . . . . . . . . . . . . . . . . 11.
Skip to Line 15.
12. If Line 10 is greater than Line 6, enter the difference. This is the Tax Overpayment Amount . . . . . . . . . . . . . . . . . 12.
00
13. Amount of overpayment you want credited to next year’s estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.
00
14. Subtract Line 13 from Line 12. This is the Overpayment Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.
00
15. Addition to Tax,
Penalty,
and Interest
00
(a). Addition to Tax. Enter amount from Form 760C, if applicable. . . . . . . . . . . . . . . . . . . . . . . . . 15(a).
(b). Penalty - See instructions. If owed, check applicable box and enter amount:
00
Late Filing Penalty or
Extension Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15(b).
00
(c). Interest - Compute on amount from Line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15(c).
00
(d). Add Lines 15(a) - 15(c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15(d).
16. If you owe tax on Line 11, add Lines 11 and 15(d) -or- If Line 14 is an overpayment and Line 15(d)
00
is greater than Line 14, enter the difference. This is the AMOUNT YOU OWE. Attach payment. . . . . . . . . . . . . . . 16.
17. If Line 14 is greater than Line 15(d), Subtract Line 15(d) from Line 14.
00
This is YOUR REFUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.
Complete And Attach Schedule L
I, the undersigned owner and authorized representative of the pass-through entity declare under the penalties provided by law that this return (including
any accompanying schedules, statements, and attachments) has been examined by me and is, to the best of my knowledge and belief, a true, correct, and
complete return, made in good faith, for the taxable year stated, pursuant to the tax laws of the Commonwealth of Virginia. I declare that the pass-through
entity has made a diligent effort to ensure that the owners who are participating in this return are qualified to do so. I further declare that the pass-through entity
has in its possession a signed statement from each owner participating in the return that grants the pass-through entity the authority to act on the owners’
behalf in the matter of the return and that indicates the owners’ understanding and acceptance of all the terms and conditions for the filing of such a return.
I authorize the Department of Taxation to discuss this return with my preparer. If yes, check here.
Signature of Owner or Authorized Representative
Title
Date
Printed Name of Owner or Authorized Representative
Phone
Individual or Firm, Signature of Preparer
Phone Number
Preparer’s FEIN
Date
Address
Approved Vendor Code
For Office Use Only
Va. Dept. of Taxation 2601018 Rev. 08/16

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