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Form D-400tc - General Information For Claiming Tax Credits, Form D-429 - Worksheet For Determining The Credit For The Disabled Taxpayer Page 5

Worksheet for Determining the Credit for the

D-429

Disabled Taxpayer, Dependent or Spouse

10-03

North Carolina Department of Revenue

For taxable year ___________

(See the instructions on reverse to determine if you are eligible for either of these credits)

mportant: Do not file this form with your North Carolina return. Keep it for your records. However, if you claim this credit you must

attach Federal Schedule R (Credit for the Elderly or Disabled) or Schedule 3, Form 1040A, to your North Carolina return.

Credit for Disabled Taxpayer

1. If you check boxes 2, 4, 5, 6, or 9 on Page 1 of Schedule 3, Part I of Form 1040A, or on

Page 1 of Federal Schedule R, enter the amount of the credit from the applicable federal

schedule in the space below and divide by 3

$ ____________

3 =

Amount from Line 22, Schedule 3 OR Line 24, Schedule R:

(

If you do not claim the credit for a disabled dependent or a disabled spouse, skip Lines 2 through 12 and go to Line 13.)

Credit for Disabled Dependent or Disabled Spouse

2. Enter your federal adjusted gross income from your federal return, Form 1040, Line 34 or

Form 1040A, Line 21

3. Enter the applicable additions shown on Form D-400, Lines 35 through 37

4. Add Lines 2 and 3

5. Enter the applicable deductions shown on Form D-400, Lines 39 thorugh 44

6. Line 4 minus Line 5 (Important: If the result on this line is equal to or less than the

base income amount for your filing status, skip Lines 7 though 11 and enter on Line

12 below the initial credit from the table below)

7. Enter the base income amount for your filing status from the table below

8. Line 6 minus Line 7

9. Divide the amount on Line 8 by $1,000 and round the result down to the next whole

number

10.

10. Multiply the number on Line 9 by $4.00

11. Enter the initial credit for your filing status from the table below

11.

12. Credit for Disabled Dependent or Disabled Spouse: If Line 10 is more than Line 11, enter

zero here. If Line 10 is less than Line 11, subtract Line 10 from Line 11 and enter the result here

12.

13. Add Lines 1 and 12 (Full-year residents enter the result here and on Line 23, Part 4, Form

13.

D-400TC - Individual Tax Credits)

14. If you were a nonresident or a part-year resident of North Carolina during the tax year,

multiply the amount on Line 13 above by the decimal amount from Line 12 of Form D-400 and

14.

enter the result here and on Line 23, Part 4, Form D-400TC - Individual Tax Credits

Base

Filing Status

Initial Credit

Income Amount

Single

$48

$12,000

Head of Household

$64

$16,000

Qualifying Widow(er) With Dependent

Child or Married Filing Jointly

$80

$20,000

Married Filing Separately

$40

$10,000

Form D-400tc - General Information For Claiming Tax Credits, Form D-429 - Worksheet For Determining The Credit For The Disabled Taxpayer Page 5

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