Form 1041n - Nebraska Fiduciary Income Tax Return - 2015

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Nebraska Fiduciary Income Tax Return
FORM 1041N
2015
for the taxable year January 1, 2015 through December 31, 2015 or other taxable year
beginning
, 2015 and ending
, 20
Name of Estate or Trust
PLEASE DO NOT WRITE IN THIS SPACE
Name and Title of Fiduciary
Street or Other Mailing Address of Fiduciary
City
State
Zip Code
Nebraska ID Number
Federal ID Number
Type of Trust (If Grantor Type, See Instructions)
23 —
Testamentary
Inter Vivos
Grantor Type
Status of Estate or Trust
Type of Return
(1)
Resident
(2)
Nonresident
Estate
Simple Trust
Complex Trust
ESBT
Bankruptcy Estate
Amended Return
Check applicable boxes:
(1)
Initial Nebraska Return
(2)
Final Return
(3)
Change in Address
(4)
7004 Attached
(5)
Distributed Form 3800N Credit
Does the estate or trust have nonresident individual beneficiaries?
Is the trust a pooled income fund?
YES (Complete Schedule II)
NO
YES
NO
1 Total federal income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
00
2 Federal taxable income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
00
3 Undistributed income from U.S. government bonds or other U.S. obligations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
00
4 Undistributed income from non-Nebraska state and local bond interest and other Nebraska adjustments
increasing federal taxable income (attach a schedule) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
00
5 Special Capital Gains/Extraordinary Dividend Deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
00
6 Nebraska adjustments decreasing federal taxable income (attach a schedule) (see instructions) . . . . . . . . . . . . 6
00
7 Nebraska taxable income (line 2 plus line 4) minus (lines 3, 5, and 6). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
00
Nonresident estates and trusts, except those receiving esbt income, should not make entries on lines 8 AND 9.
Instead, Nonresident estates and trusts must complete Nebraska Schedule I to determine the Line 10 entry.
8 Nebraska income tax (use the tax rate schedule on page 8 of instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
00
9 Nebraska other tax (Federal Form 4972) (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
00
10 Total Nebraska tax (total of lines 8 and 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
00
11 Nebraska income tax withholding for nonresident individual beneficiaries [total of column (G), Schedule II]. . . . 11
00
12 Total Nebraska income tax liability (line 10 plus line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
00
13 Credit for tax paid by resident estate or trust to other states (Schedule III) . . . . . . 13
00
14 Community Development Assistance Act credit and Financial Institution Tax credit
14
00
15 Form 3800N nonrefundable credit (attach Form 3800N) . . . . . . . . . . . . . . . . . . . . . 15
00
16 Total nonrefundable credits (total of lines 13, 14, and 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
00
17 Subtract line 16 from line 12 (if line 16 is greater than line 12, enter zero -0-). . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
00
18 Form 3800N refundable credit (attach Form 3800N) . . . . . . . . . . . . . . . . . . . . . . . . 18
00
19 Tax deposited with Form 7004N and 2015 estimated income tax payments . . . . . . 19
00
20 Beginning Farmer credit (attach certificate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
00
21 Angel Investment Tax credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
00
22 Other credits (attach Nebraska copy of Federal Forms W-2, 1099-R, or W-2G) . . . . 22
00
23 Total payments (total of lines 18, 19, 20, 21, and 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
00
24 TAX DUE (if line 17 is greater than line 23, subtract line 23 from line 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
00
25 OVERPAYMENT (if line 23 is greater than line 17, subtract line 17 from line 23) . . . . . . . . . . . . . . . . . . . . . . . . . 25
00
26 Overpayment on line 25 you want credited to 2016 estimated income tax . . . . . . . . . . . . . . . . . . . . . . . . . . 26
00
27 Overpayment to be REFUNDED (line 25 minus line 26). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
00
Under penalties of perjury, I declare that as taxpayer or preparer, I have examined this return, including accompanying schedules and statements,
and to the best of my knowledge and belief, it is correct and complete.
sign
here
Signature of Fiduciary or Officer Representing Fiduciary
Date
Email Address
(
)
Title
Phone Number
paid
preparer’s
Preparer’s Signature
Date
Preparer’s PTIN
use only
(
)
Firm’s Name (or yours if self-employed), Address and Zip Code
EIN
Daytime Phone
A copy of the federal return and schedules must be attached to this return.
Mail this return and payment to: Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818.
8-424-2015

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