Form 765 - Unified Nonresident Individual Income Tax Return - 2013

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*VA0765113888*
2013 VIRGINIA
Unified Nonresident
Individual Income
Form 765
Department of Taxation
Tax Return
P. O. Box 760
Richmond, VA 23218-0760
FISCAL or SHORT Year Filer: Beginning Date
For Qualified Owners of a Pass-Through Entity
Ending Date
Legal Name of Pass-Through Entity
Official Use Only
Check if -
Change In Address
Number and Street
Legal Name Change
Address Continued
Federal Employer ID Number
Amended Return
City or Town, State and ZIP
Virginia Account Number
760C Attached
PART I : Participants’ Combined Income
1. Virginia Income (From Part II, Line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.
00
2. Total Additions (From Part II, Line 11, Column B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
00
00
3. Subtotal (Add Line 1 and Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.
00
4. Total Subtractions (From Part II, Line 17, Column B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
00
5. Virginia Taxable Income (Line 3 Minus Line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.
00
6. Amount of Tax (Round To Whole Dollars) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.
00
7. Estimated Tax Paid For Taxable Year 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.
00
8. Extension Payment (From Form 770-IP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.
00
9. Total Credits (From Attached Schedule CR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.
1 0. Total Payments and Credits (Add Lines 7, 8 and 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10.
00
00
1 1. If Line 6 is Greater than Line 10, Enter The Difference. This is the Income Tax You Owe . . . . . . . . . . . . . . . . . . . 11.
Skip to Line 15.
1 2. If Line 10 is Greater than Line 6, Enter the Difference. This Is The Tax Overpayment Amount . . . . . . . . . . . . . . 12.
00
13. Amount of Overpayment You Want Credited to Next Year’s Estimated Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.
00
14. Subtract Line 13 from Line 12. This is the Overpayment Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.
00
15. Addition to Tax, Penalty and Interest
00
(a). Addition to Tax. Enter Amount From Form 760C, If Applicable . . . . . . . . . . . . . . . . . . . . . . . . .15(a)
(b). Penalty - See Instructions. If Owed, Check Applicable Box and Enter Amount:
00
Late Filing Penalty or
Extension Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15(b)
00
(c). Interest - Compute on Amount From Line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15(c)
00
(d). Add Lines 15(a) - 15(c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15(d)
1 6. If You Owe Tax on Line 11, Add Lines 11 and 15(d) -or- If Line 14 is an Overpayment and Line 15(d)
00
is Greater than Line 14, Enter the Difference. This is the Amount You Owe. Attach Payment. . . . . . . . . . . . . . . . . 16.
1 7. If Line 14 is Greater than Line 15(d), Subtract Line 15(d) From Line 14.
00
This is the Amount to be Refunded to You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.
Complete And Attach Schedule L
I, the undersigned owner and authorized representative of the pass-through entity declare under the penalties provided by law that this return (including
any accompanying schedules, statements and attachments) has been examined by me and is, to the best of my knowledge and belief, a true, correct and
complete return, made in good faith, for the taxable year stated, pursuant to the tax laws of the Commonwealth of Virginia. I declare that the pass-through
entity has made a diligent effort to ensure that the owners who are participating in this return are qualified to do so and that all owners who qualify to participate
in this return are doing so. I further declare that the pass-through entity has in its possession a signed statement from each owner participating in the return
that grants the pass-through entity the authority to act on the owners’ behalf in the matter of the return and that indicates the owners’ understanding and
acceptance of all the terms and conditions for the filing of such a return.
I authorize the Department of Taxation to discuss this return with my preparer. If yes, check here.
(Signature of Owner or Authorized Representative)
(Title)
(Date)
(Printed Name of Owner or Authorized Representative)
(Phone)
(Individual or Firm, Signature of Preparer)
(Phone Number)
(Preparer’s FEIN)
(Date)
(Address)
Approved Vendor Code
For Office Use Only
Va. Dept. Of Taxation 2601018 765 F (REV 12/13)

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