Form 1npr Draft - Nonresident & Part-Year Resident Wisconsin Income Tax - 2011 Page 2
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51NPR
Nonresident & part-year resident
2011
Wisconsin income tax
Check here
For the year Jan. 1-Dec. 31, 2011,
if this is an
or other tax year
amended
beginning:
, 2011
return
ending:
, 20
.
Your social security number
Spouse’s social security number
Legal first name
Your legal last name
M.I.
Tax district
Check below then fill in either the name of Wisconsin city,
village, or town, and the county in which you lived at the
Spouse’s legal first name
If a joint return, spouse’s legal last name
M.I.
end of 2011 or before leaving Wisconsin (nonresidents
leave blank).
Home address (number and street). If you have a PO Box, see page 7
Apt. no.
City
Village
Town
City, village,
or town
City or post office
State
Zip code
County of
Filing status
Special
School district number
(see page 39)
Conditions
Single
Married filing joint return (even if only one had income)
Legal
Married filing separate return.
last name
Fill in spouse’s SSN above and
M.I.
Legal
full name here .........................
first name
Head of household (with qualifying person), (see page 7).
Also, check here if married.
Print numbers like this
Resident status
Check the status that applies
You
Spouse
NO COMMAS; NO CENTS
Full-year resident of Wisconsin
Nonresident of Wisconsin; state of residence
(2-letter state abbreviation)
Note: Complete residence questionnaire, page 47.
Part-year resident of Wisconsin from
to
mm
dd
yyyy
mm
dd
yyyy
If Yes, enter Minnesota income:
Wisconsin residents working in Minnesota: Was any of your income from personal or
No
Yes
professional services performed in Minnesota while a Wisconsin resident?
(See instructions, page 8)
.00
If Yes, enter Wisconsin income:
Minnesota residents working in Wisconsin: Was any of your income from personal or
No
Yes
professional services performed in Wisconsin while a Minnesota resident?
.00
(See instructions, page 8)
A. Federal column
B. Wisconsin column
Income
.00
.00
1 Wages, salaries, tips, etc. (see page 10) . . . . . . . . . . . . . . . . . . . . . . . .
1
.00
.00
2 Taxable interest (see page 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
.00
.00
3 Ordinary dividends (see page 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4 Taxable refunds, credits, or offsets of state and local income taxes
.00
Not taxable
(from federal Form 1040, line 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
.00
.00
5 Alimony received (from federal Form 1040, line 11) . . . . . . . . . . . . . . . .
5
.00
.00
6 Business income or (loss) (from federal Form 1040, line 12) . . . . . . . . .
6
.00
.00
7 Capital gain or (loss) (see page 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
.00
.00
8 Other gains or (losses) (from federal Form 1040, line 14) . . . . . . . . . . .
8
.00
.00
9 IRA distributions (see page 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
.00
.00
10 Pensions and annuities (see page 13) . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Rental real estate, royalties, partnerships, S corporations, trusts, etc.
.00
.00
(from federal Form 1040, line 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
.00
.00
12 Farm income or (loss) (from federal Form 1040, line 18) . . . . . . . . . . . . 12
.00
.00
13 Unemployment compensation (see page 14) . . . . . . . . . . . . . . . . . . . . . 13
14 Social security benefits (see page 15) . . . . . . . . . . . . . . . . . . . . . . . . . . 14
.00
Not taxable
15 Other income (see pages 15-21). Enclose explanation . . . . . . . . . . . . . 15
.00
.00
16 Add lines 1 through 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
.00
.00
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