Form 1040n - Nebraska Individual Income Tax Return - Department Of Revenue - 2012

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Nebraska Individual Income Tax Return
FORM 1040N
2012
for the taxable year January 1, 2012 through December 31, 2012 or other taxable year:
, 2012 through
,
Your First Name and Initial
Last Name
PLEASE DO NOT WRITE IN THIS SPACE
If a Joint Return, Spouse’s First Name and Initial
Last Name
Current Mailing Address (Number and Street or PO Box)
City
State
Zip Code
IMPORTANT:
High School District Code
SSN(S) MUST BE ENTERED BELOW.
Your Social Security Number
Spouse’s Social Security Number
(Must be entered using high
school codes.)
(1)
Farmer/Rancher
(2)
Active Military
(1)
Deceased Taxpayer(s)
(first name & date of death):
1
Federal Filing Status:
(1)
Single
(3)
Married, filing separately –
;
(4)
Head of Household
Spouse’s SSN:
(2)
Married, filing jointly
(5)
Widow(er) with dependent children
and Full Name
2a Check if YOU were:
2b
(1)
65 or older
(2)
Blind
Check here if someone (such as your parent) can claim you or
SPOUSE was:
65 or older
your spouse as a dependent: (1)
You
(2)
Spouse
(3)
(4)
Blind
3 Type of Return:
(attach Schedule III)
(2)
Partial-year resident from
/
, 2012 to
/
/
(1)
Resident
Nonresident (attach Schedule III)
(3)
4 Federal exemptions (number of exemptions claimed on your 2012 federal return) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5 Federal adjusted gross income (AGI) (Federal Form 1040EZ, line 4; Federal Form 1040A, line 21;
Federal Form 1040, line 37) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
00
6 Nebraska standard deduction (if you checked any boxes on line 2a or 2b above,
see instructions; otherwise, enter $5,950 if single; $11,900 if married, filing jointly or
6
qualified widow[er]; $5,950 if married, filing separately; or $8,700 if head of household)
00
7 Total itemized deductions (Federal Schedule A, line 29 – see instructions) . . . . . . .
7
00
8 State and local income taxes (Federal Form 1040, line 5, Schedule A –
see instructions .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
00
9 Nebraska itemized deductions (line 7 minus line 8) . . . . . . . . . . . . . . . . . . . . . . . . .
9
00
10 Enter the amount from line 6 or line 9, whichever is greater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
00
11 Nebraska income before adjustments (line 5 minus line 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
00
12 Adjustments increasing federal AGI (line 50, from attached Nebraska Schedule I) 12
00
13 Adjustments decreasing federal AGI (line 58, from attached Nebraska Schedule I) 13
00
14 Nebraska Taxable Income (enter line 11 plus line 12 minus line 13) . If less than -0-, enter -0- . . . . . . . . . . . . 14
00
15 Nebr . income tax (Resident paper filers may use the Nebr . Tax Table; all others must
use Tax Calculation Sch . Partial-year residents and nonresidents use Nebr . Sch . III.) 15
00
16 Nebraska minimum or other tax:
Federal Alternative Minimum tax (Recalculated Form 6251) . . .$______________
Federal Tax on Lump Sum Distributions (Form 4972) . . . . . . . .$______________
Federal Tax on Early Distributions (Lesser of Form 5329 or
line 58 Form 1040) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$______________
Total
$______________
Multiply total (on the line immediately above) by 29 .6% ( .296) and enter the
result on line 16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
00
17 Total Nebraska tax before personal exemption credit (add lines 15 and 16) . Do not pay the amount on this
line . Pay the amount from line 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
00
COMPLETE REVERSE SIDE
8-417-2012

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