Form 43 Draft - Idaho Part-Year Resident & Nonresident Income Tax Return - 2009
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1
28734
F
43
2009
O
IDAHO PART-YEAR RESIDENT & NONRESIDENT INCOME TAX RETURN
R
M
EFO00091 08-21-09-v5
.
State Use Only
AMENDED RETURN, check the box.
.
See instructions, page 12 for the reasons
for amending and enter the number.
Your Social Security Number (required)
For calendar year 2009, or fiscal year beginning , ending
Your first name and initial
Last name
Spouse's Social Security Number (required)
Spouse's first name and initial
Last name
Mailing address
Do you need Idaho
Taxpayer deceased
income tax forms
in 2009
City, State, and Zip Code
mailed to you next year?
.
.
Spouse deceased
.
in 2009
If you or your spouse are nonresident aliens for federal purposes, check here.
Yes
No
. .
. .
. .
. .
. .
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.
If filing married joint or separate return, enter spouse's name and Social Security number above.
1.
Single 2.
Married filing joint return
3.
Married filing separate return
4.
Head of household
5.
Qualifying widow(er)
Yourself a.
6. EXEMPTIONS.
If someone can claim you as a
Enter "1" in boxes 6a,
Election campaign fund
dependent, leave box 6a blank.
and 6b, if they apply.
Spouse
b.
I want $1 of my income tax to go to the Idaho
Election Campaign Fund ($2 on joint return).
c. List your dependents. If more than four dependents, continue on Form 39NR.
Enter the total number here ................................................................................ c.
7. Yourself 8. Spouse
7. Yourself 8. Spouse
.
.
First name
Last name
Social Security Number
___________________________________________________________________
Constitution
Republican
.
.
___________________________________________________________________
No Specific
Democratic
___________________________________________________________________
.
.
Libertarian
None
___________________________________________________________________
___________________________________________________________________
d. Total exemptions. Add lines 6a through 6c. Must match federal return ............ d.
.
Idaho Amounts
IDAHO INCOME. See instructions, page 14.
00
.
9. Wages, salaries, tips, etc. Attach Form(s) W-2 .............................................................................................
9
00
10. Taxable interest income ..................................................................................................................................
.
10
00
.
11. Dividend income .............................................................................................................................................
11
00
12. Alimony received ............................................................................................................................................
.
12
00
13. Business income or (loss). Attach federal Schedule C or C-EZ ....................................................................
.
13
00
14. Capital gain or (loss). If required, attach federal Schedule D ........................................................................
.
14
00
15. Other gains or (losses). Attach federal Form 4797 ........................................................................................
.
15
00
.
16. IRA distributions (taxable amount) ................................................................................................................
16
00
17. Pensions and annuities (taxable amount) ......................................................................................................
.
17
00
18. Rents, royalties, partnerships, S corporations, trusts, etc. Attach federal Schedule E ..................................
.
18
00
19. Farm income or (loss). Attach federal Schedule F ........................................................................................
.
19
00
20. Unemployment compensation ........................................................................................................................
.
20
00
21. Other income. Attach explanation .................................................................................................................
21
00
22. TOTAL INCOME. Add lines 9 through 21 ......................................................................................................
22
.
IDAHO ADJUSTMENTS. See instructions, page 14.
00
.
23. Deductions for IRAs and health savings account ...........................................................................................
23
00
.
24. Moving expenses. Attach federal Form 3903 ................................................................................................
24
00
.
25. Deductions for self-employment tax, health insurance, and qualified retirement plans ..................................
25
00
.
26. Penalty on early withdrawal of savings ..........................................................................................................
26
00
27. Other deductions. See instructions ...............................................................................................................
27
00
28. TOTAL ADJUSTMENTS. Add lines 23 through 27 .......................................................................................
28
.
29. ADJUSTED GROSS INCOME. Subtract line 28 from line 22
.
00
If you have an NOL and are electing to forego the carryback period, check here
.............................
29
.
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
ATTACH A COMPLETE COPY
.
HERE
Spouse's signature (if a joint return, BOTH MUST SIGN)
Daytime phone
{¢g¦}
OF YOUR FEDERAL RETURN.
.
.
Paid preparer's signature
Preparer's EIN, SSN, or PTIN
Address and phone number
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