Form 481.0 - Individual Income Tax Return - Department Of Treasury Of Puerto Rico - 2010 Page 2
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1
2
3
4Taxpayer's Social Security Number
Form 481.0, Rev. 12.10 - Page 2
Part 3
Taxpayer's name ________________________________
E
S
1
0
1
0
Adjusted Gross Income (From line 4, page 1)................................................................................................................
(01)
4.
02
.
0
0
,
STANDARD DEDUCTION AND PERSONAL EXEMPTION: If you checked box 1 in Part 1 enter $6,150,
5.
box 2 enter $3,400, box 3 enter $5,730, box 4 enter $3,400 ...........................................................................................
.
0
0
(02)
,
ADDITIONAL DEDUCTIONS
6.
A. Contributions to individual retirement accounts (Do not exceed from $5,000 or $10,000 if married):
Employer Identification Number
Contribution
Financial institution
Account number
(03)
.
0
0
(06)
,
Employer Identification Number
Contribution
Financial institution
Account number
.
(04)
0
0
(07)
,
Employer Identification Number
Contribution
Financial institution
Account number
(08)
.
(05)
,
0
0
Total contributions to individual retirement accounts (Add all the amounts
.
,
0
0
reflected on line 6A) ..............................................................................................
(09)
B. Contributions to health savings accounts with a high annual deductible medical plan (See instructions):
Contribution
Employer Identification Number
Institution
Account number
(10)
(14)
.
0
0
,
___________________________________
___________________________________
Effective date
Annual deductible
Type of coverage:
1 Individual
2 Individual and age 55 or older
(15)
(18)
.
(11)
0
0
,
3 Family
4 Family and age 55 or older
Day
Month
Year
Contribution
Employer Identification Number
Institution
Account number
.
(12)
(16)
0
0
,
___________________________________
___________________________________
Effective date
Annual deductible
Type of coverage:
1 Individual
2 Individual and age 55 or older
(17)
(19)
.
0
0
(13)
,
Day
Month
Year
3 Family
4 Family and age 55 or older
Total contributions (Add the smaller amount between
.
the contribution and the annual deductible of each account) .........................................
,
0
0
(20)
.
,
0
0
C. Contributions to governmental pension or retirement systems ........................................
(21)
.
,
0
0
D. Deduction for Veterans (See instructions) .....................................................................
(22)
.
0
0
,
E. Ordinary and necessary expenses (Schedule I Individual, Part I, line 8) .....................
(23)
F. Automobile loan interest: (Do not exceed $1,200)
Financial Institution _____________________ Loan Number ____________________
.
,
0
0
Employer Ident. Number
(24)
(25)
.
0
0
,
G. Young people who work (See instructions) ...................................................................
(26)
.
,
0
0
H. Educational Contribution Account (Schedule A1 Individual, Part II, line (10))(See instructions).........
(27)
.
0
0
,
I. Acquisition and installation of a personal computer used by dependents (See inst.) ......
(28)
.
0
0
,
J. Contributions to the Endowment Fund of the University of Puerto Rico ...........................
(29)
.
0
0
,
K. Deduction when both spouses work (See instructions) ..................................................
(30)
.
,
0
0
L. Total Additional Deductions (Add lines 6A through 6K) .............................................................................................
(31)
Retention Period: Ten (10) years
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