Form 200-02-X - Non-Resident Amended Delaware Personal Income Tax Return - 2012
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1
2DO NOT WRITE OR STAPLE IN THIS AREA
DELAWARE
FORM 200-02-X
TAX YEAR 2012
NON-RESIDENT AMENDED
DELAWARE PERSONAL INCOME TAX RETURN
or Fiscal year beginning _______________ and ending _______________
Your Social Security No.
Spouse’s Social Security No.
FILING STATUS (MUST CHECK ONE)
1.
Single, Divorced, Widow(er)
3.
Married & Filing Separate Forms
Your Last Name
Your First Name and Middle Initial
Jr., Sr., III., etc
2.
Joint
5.
Head of Household
Spouse’s Last Name
Spouse’s First Name
Jr., Sr., III., etc
Form DE2210
Check if a full year non-resident in the tax year
Attached
Present Home Address (Number and Street)
Apt. #
If you were a part year resident in the tax year, give the dates you
resided in Delaware.
From
To
State
Zip Code
City, Town or Post Office
Month
Day
Year
Month
Day
Year
COMPLETE ALL SECTIONS OF THIS RETURN. NAMES AND SSN’S MUST MATCH ORIGINAL RETURN.
CORRECTED AMOUNTS
1.
DELAWARE ADJUSTED GROSS INCOME....................................................................................................................................
1
00
2.
(a) If you elect the STANDARD DEDUCTION check here..............................................................
a.
Filing Statuses 1, 3 & 5 - $3250
Filing Status 2 - $6500
(b) If you elect to ITEMIZE DEDUCTIONS check here ..................................................................
b.
2
00
3.
ADDITIONAL STANDARD DEDUCTIONS (Not allowed with Itemized Deductions - see instructions)
CHECK BOX(ES)
If SPOUSE was 65 or over
and/or Blind
If YOU were 65 or over
and/or Blind
3
00
4.
TOTAL DEDUCTIONS - ADD LINES 2 and 3 andenterhere...........................................................................................................
4
00
5.
TAXABLE INCOME - Subtract Line 4 from Line 1 and compute tax on this amount........................................................................
5
00
6.
Tax Liability Computation
A
Tax Liability from Tax
Modified Delaware Sourced Income
00
=
Proration
Rate Table/Schedule
B
Delaware Adjusted Gross Income
00
=
.
X
00
6
00
Personal Credits (See Instructions)
7a.
Enter number of exemptions claimed on Federal return _______________ X $110. = _______________
) and enter total here.......................................................... 7a
00
Multiply this amount by the proration decimal on Line 6 (X
7b.
CHECK BOX(ES)
Spouse 60 or Over (if Filing status 2)
Self 60 or Over
Enter number of boxes checked on Line 7b ________________ X $110. = _______________
) and enter total here.......................................................... 7b
00
Multiply this amount by the proration decimal on Line 6 (X
8.
Tax imposed by State of _____________(Part Year Residents only) ................
8
00
8
9.
Other Non-Refundable Credits................................................................................
9
00
9
10.
Total Non-Refundable Credits (Add Lines 7a, 7b, 8 and 9)............................................................................................................... 10
00
11.
BALANCE (Subtract Line 10 from Line 6, cannot be less than ZERO)............................................................................................
11
00
12.
Delaware Tax Withheld (W-2's and or 1099's Required)........................................ 12
00
12
13.
Estimated Tax Paid & Payments with Extensions...................................................... 13
00
13
14.
S CorpPayments and Refundable Business Credits
....................................................... 14
.
00
14
15.
2012 Real Estate Estimated Payments...................................................................... 15
00
15
16.
Amount paid (if any, see instructions)........................................................................ 16
00
16
17.
TOTAL Refundable Credits (Add Lines 12, 13, 14, 15 & 16)............................................................................................................. 17
00
18.
Refund received (if any, see instructions).......................................................................................................................................... 18
00
19.
Estimated Tax Carryover and/or Special Funds Contribution as shown on original return ............................................................... 19
00
20.
Subtract Lines 18 and 19 from Line 17..............................................................................................................................................
20
00
21.
BALANCE DUE
.
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1
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20
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20
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>
21
00
22.
OVERPAYMENT. If Line 20 is more than Line 11, subtract 11 from 20 and enter here............................................................ >
22
00
23.
AMOUNT OF LINE 22 TO BE APPLIED TO YOUR ESTIMATED TAX ACCOUNT (See Instructions).....................ENTER
>
23
00
24.
PENALTIES AND INTEREST DUE.............................................................................................................................ENTER
>
24
00
25.
NET BALANCE DUE - Enter the amount due (Line 21 plus Lines 23 and 24) and pay in full ...........................PAY IN FULL
>
25
00
26.
NET REFUND - Subtract Lines 23 and 24 from Line 22......................................................TO BE REFUNDED/ZERO DUE
>
26
00
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and believe it is true, correct and complete.
Your Signature
Date
Signature of Paid Preparer
Date
EIN,SSN or PTIN
X
X
Spouse’s Signature (If filing joint)
Date
Address
Zip Code
X
Home Phone
Business Phone
Business Phone
*DF21212019999*
Email Address
Email Address
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