Form 39nr - Idaho Supplemental Schedule - 2014 Page 2
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1
2Form 39NR - 2014
Page 2
EFO00087p2 10-01-14
Name(s) as shown on return
Social Security Number
C. Credit for Income Tax Paid to Other States by Part-Year Residents. See instructions, page 32.
.
Nonresidents cannot claim this credit. Idaho residents on active military duty, complete Part D below.
This credit is being claimed for taxes paid to: __________________________________
(State name)
1 Idaho adjusted income from Form 43, line 31, Column B ........................
1
00
.
2. Federal adjusted gross income earned in other state adjusted for
Include a copy of the
.
Idaho modifications. See instructions ......................................................
2
00
income tax return and
a separate Form 39NR
3. Amount of income taxed by Idaho, and also taxed by another state ........
3
00
for each state for which
4. Idaho tax, Form 43, line 42 .......................................................................
4
00
a credit is claimed.
5. Divide line 3 by line 1. Enter percentage here .........................................
%
5
.
6. Multiply line 4 by line 5 ....................................................................................................................
6
00
7. Other state's tax due less its income tax credits ......................................
7
00
8. Divide line 3 by line 2. Enter percentage here ..........................................
%
8
9. Multiply line 7 by line 8 ...................................................................................................................
9
00
10. Enter the smaller of line 6 or 9 here and on Form 43, line 43 .........................................................
10
00
D. Credit for Income Tax Paid to Other States by Idaho Residents on Active Military Duty.
See instructions, page 33.
This credit is being claimed for taxes paid to: __________________________________
(State name)
.
1. Idaho tax, Form 43, line 42 .......................................................................
1
00
Include a copy of the
income tax return and
2. Other state's adjusted income. See instructions .....................................
2
00
a separate Form 39NR
3. Idaho adjusted income from Form 43, line 31, Column B ........................
3
00
for each state for which
4. Divide line 2 by line 3. Enter percentage here ..........................................
a credit is claimed.
%
4
.
5. Multiply line 1 by line 4. Enter amount here ...................................................................................
5
00
.
6. Other state's tax due less its income tax credits ............................................................................
6
00
7. Enter the smaller of line 5 or 6 here and on Form 43, line 43 ........................................................
7
00
E. Credits for Contributions to Idaho Educational Entities, Idaho Youth and Rehabilitation
.
Facilities, and Live Organ Donation Expenses. See instructions, page 33.
. .
1. Credit for contributions to Idaho educational entities ......................................................................
1
00
2. Credit for contributions to Idaho youth and rehabilitation facilities ..................................................
2
00
3. Credit for live organ donation expenses .........................................................................................
3
00
4. Total credits. Add lines 1 through 3. Enter total here and on Form 43, line 44 .............................
4
00
F. Maintaining a Home for a Family Member Age 65 or Older, or a Family Member With a
Developmental Disability. See instructions, page 34.
1. Did you maintain a home for an immediate family member age 65 or older and provide more than
Yes
No
one-half of his/her support? You and your spouse do not qualify .................................................
2. Did you maintain a home for an immediate family member with a developmental disability and
Yes
No
provide more than one-half of his/her support? You and your spouse may qualify .......................
3. List each family member you are claiming:
Check here if
Date of Birth of
Social Security Number
Relationship to Person
Name of Family Member
developmen-
Family Member
First Name
Last Name
of Family Member
Filing Return
tally disabled
4. Total amount claimed ($100 for each qualifying member but not more than $300).
Enter here and on Form 43, line 63. (Credit cannot be claimed if you took $1,000 deduction
00
4
on Part B, line 11.) ...................................................................................................................
G. Dependents: (Continued from Form 43, page 1, Line 6c)
Social Security Number
First Name
Last Name
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